急诊内科急性腹痛患者的诊治体会 史利飞.docVIP

精品论文 参考文献 急诊内科急性腹痛患者的诊治体会 史利飞 史利飞 湖南省郴州市第四人民医院 湖南郴州 423000 [摘要] 急性腹痛的临床表现是患者出现腹部阵发性痛感，一般是由于腹部内或者腹腔外器官疾病所造成的，属于临床上较为常见的内科急诊疾病。本文就我 院2 例急诊内科腹痛误诊病例阐述急诊内科急性腹痛患者的诊治体会，认为急诊内科急性腹痛在急诊工作中是一种最常见的急诊主诉，病因复杂，接诊医师应具 有全面的医学知识，丰富的临床经验，同时详细询问病史、用药史，细心观察，结合相关检查，才能减少漏诊误诊的发生。 [关键词] 急诊内科 急性腹痛 误诊 诊治体会 Diagnosis and treatment experience of the patients of acute abdominal pain in emergency internal medicine. Chenzhou Fourth Peoples Hospital of Hunan province Shi Lifei Hunan Chenzhou 423000 [Abstract] Clinical manifestations of acute abdominal pain in patients is pain with paroxysmal abdominal, which is generally caused by the disease of the abdomen or abdominal organs. And it belongs to the more common clinical department disease of internal medicine emergency. In this paper, according to the diagnosis and treatment experience of 2 cases in our hospital emergency internal medicine emergency which is misdiagnosed as abdominal pain, emergency internal medicine acute abdominal pain is one of the most common complaints in emergency. Emergency work pathogeny is complex, and the doctor should have comprehensive medical knowledge, clinical experience, also a detailed history, medication history, careful observation, combined with the relevant inspection, in order to reduce the occurrence of misdiagnosis. [Key words] acute abdomen misdiagnose clinically emergency internal medicine diagnosis and treatment 急性腹痛的临床表现是患者出现腹部阵发性痛感，一般是由于 腹部内或者腹腔外器官疾病所造成的，属于临床上较为常见的内科 急诊疾病【1】。临床上误诊率及漏诊率均较高【2】，本文就我院2 例急诊内科腹痛误诊病例报告如下。 1 临床资料 患者，女，53 岁，中上腹痛伴恶心发热一日余，于2012 年12 月12 日来院急诊内科就诊。查：神志清，语言流利，表情痛苦。体 温37.9℃，血压16/11kPa，腹平坦，未见肠型及蠕动波，中上腹压 痛明显，右下腹轻微压痛，无肌紧张。结肠充气试验及腰大肌试验 阴性。急检血常规，血中白细胞11.4times;109/L，分叶0.79，淋巴细胞 0.20，腹透肠腔轻度积气，B 超检查未见异常。结合病史体征及化验 检查，临床诊断为急性阑尾炎。入院后给予禁食水、抗炎、补液治 疗。观察病情变化。3 小时后该患者恶习呕吐加重，并且出现口渴、 头痛、嗜睡、呼吸深快，闻呼出气中有烂苹果味。逐渐出现烦躁、 四肢厥冷，此时临床怀疑糖尿病酮症酸中毒，急检血糖、尿糖、酮 体。 化验结果血糖50.4mmol/L，血酮5.5 mmol/L，尿糖（++++）。二 氧化碳结合率低。请内分泌科会诊，明确诊断为糖尿病酮症酸中毒。 转入内