急性腹痛伴糖尿病酮症酸中毒诊治分析.docVIP

·3113 · · 临 床 诊 疗 提 示 · 急性腹痛伴糖尿病酮症酸中毒诊治分析 刘志贤，刘会东，厉胜 【摘要】 目的 探讨急性腹痛伴糖尿病酮症酸中毒 (DKA) 患者的临床表现、误诊原因与诊疗对策。方法 对 2005年8月—2010年8月以腹痛为主要症状同时伴有DKA 的84例患者的临床资料进行回顾性分析，根据主要诊断将 84例患者分为急腹症组(急腹症伴 DKA)58 例、非急腹症组(由其他内科疾病引起腹痛伴 DKA)21 例、DKA 组 (仅有DKA)5 例。结果 急腹症组腹膜炎体征阳性率、影像学检查阳性结果与局部体征符合率均高于非急腹症组和 DKA 组，初诊误诊率和非手术治疗后24、48、72 h 缓解率均低于非急腹症组和DKA 组，差异有统计学意义 (P 0.05)。3组死亡率〔5.2%(3/58)、4.8%(1/21)、0〕间差异无统计学意义 (P0.05)。 结论 出现腹膜炎体征、 影像学检查阳性结果与局部体征符合以及保守性治疗后腹痛早期缓解，有助于腹痛伴 DKA 的病因诊断，并影响治疗措 施和预后。 【关键词】 糖尿病酮症酸中毒；腹痛；误诊 【中图分类号】 R587.22 【文献标识码】 B doi:10.3969/j.issn.1007-9572.2013.09.061 刘志贤，刘会东，厉胜。急性腹痛伴糖尿病酮症酸中毒诊治分析 [J]. 中国全科医学，2013,16(9):3113- 3115.[www.chinagp. net] Diagnosis and Treatment of Diabetic Ketoacidosis Accompanied by Acute Abdominal Pains LIU Zhi - xian,LIU Hui- dong,Ll Sheng. Shijingshan Teaching Hospital of Capial Medical University,Beijing Shijingshan Hospital,Beijing 100043, China 【Abstract】 Objective To study the clinical manifestations, misdiagnoses of acute abdominal pains accompanied by diabetic ketoacidosis(DKA) and its treatment measures. Methods A retrospective analysis was carried out on the clinical data of 84 patients from August 2005 to August 2010 with DKA accompanied by acute abdominal pains. The patients were divided, according to the main diagnoses, into groups A(having acute abdominal pains combined with DKA,n=58), B(having ab- dominal pains caused by other medical diseases accompanied by DKA,n=21),C(having only DKA,n=5). Results The positive rate of peritonitis sign and coincidence rate of imaging positive results with local sign were higher in group A than in groups B,C; the misdiagnosis rate of preliminary diagnosis and remission rates after hours 24, 48,72 of non - surgical treat- ment were lower in group A than in groups B,C, the difference was significant (P0.05). No difference was noted in mortali- ty between groups A,B, C(5.2%,4.8%,0,respectively,P0.05). Conclusion Coincidence of peritonitis, imaging positive results with abdo