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等我长大了把你手脚摁住打一针

2018-03-23 50页 doc 164KB 16阅读

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等我长大了把你手脚摁住打一针等我长大了把你手脚摁住打一针 故事小说 昨天4岁的儿子发烧去打针。“不打不打。”哇哇哇...... 小护士:把他手脚摁住了。 儿子立马不哭了,打完直视小护士说:你吖整天只会打针,等我长大了把你手脚摁住打一针。 小护士笑喷了...... 为科学有效地进行危重病的临床和科研工作,必须有衡量危重患者病情严重程度,并被不同国家、不同医院普遍接受的标准,这种标准称为危重病预后评分系统。 1 危重病评分的临床应用现状 危重疾病评分方法的应用目的为定量评估疾病的严重程度和预测疾病或患者死亡的危险性。传统方法将疾病的严重程度分...
等我长大了把你手脚摁住打一针
等我长大了把你手脚摁住打一针 故事小说 昨天4岁的儿子发烧去打针。“不打不打。”哇哇哇...... 小护士:把他手脚摁住了。 儿子立马不哭了,打完直视小护士说:你吖整天只会打针,等我长大了把你手脚摁住打一针。 小护士笑喷了...... 为科学有效地进行危重病的临床和科研工作,必须有衡量危重患者病情严重程度,并被不同国家、不同医院普遍接受的标准,这种标准称为危重病预后评分系统。 1 危重病评分的临床应用现状 危重疾病评分方法的应用目的为定量评估疾病的严重程度和预测疾病或患者死亡的危险性。传统方法将疾病的严重程度分轻、中、重3级;而危重疾病评分法观察患者的急性生理改变、解剖学改变,甚至慢性疾病的病损因素等参数,通过赋值、加权以及逻辑推理和复杂的数学运算,从而客观地量化评价疾病的严重程度。这些量化评估结果对于医生和护士了解和掌握病情,动态观察病情变化非常重要。 探讨评估结果与并发症、病死率、住院时间、药物治疗和医疗护理措施等方面之间的关系,有利于、提高技术和学术水平,发现疾病发生和发展的客观规律,甚至总结经验教训;另一方面,在危重疾病研究中往往用评分分值作为分组依据;在许多研究中用评分来控制组间条件,从而增加组间的可比性。 危重疾病评分工具的另一作用是用来预测疾病预后或死亡的危险性(Ps)。这类评分工具通常以0.5作为Ps的界点,Ps>0.5为预测存活,Ps<0.5为预测死亡。对于某一群体来说,预测死亡(存活)与实际进行比较,二者越接近,预测效果越大。然而预测病死率主要进行流行病学研究,而为每个患者预测的Ps不能作为implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 是否放弃治疗的根据。 第二代的APACHE?是迄今为止影响最大的ICU预后评估系统。不论是外科创伤还是内科急症,APACHE?在应用中都得到很高的评价,既可根据评分的高低评价病情的严重程度,又可凭借得出的病死危险度判断患者的预后,是目前临床ICU中应用最广泛、最权威性的危重病情评价系统。虽然在APACHE?的运用中积累了很多成功的经验,但有些参数在我国大多数基层医院不易收集齐。若有些参数缺少,该系统即认为是正常,按此计分多有失误。况且收集各项资料,如某些生化指标,是需要一定测量时间的,往往延误危重患者的抢救。该评估系统目前还存在以下问题: (1)选择的评分指标有很大的主观性,缺乏有力的统计模型来支持。(2)在计算和推测死亡概率方面无能为力。(3)用于群体预测较准确,但用于个体死亡预测则有较大的偏差。 2 中医危重病评分的理论依据 中医学在危重病情的预测和评价方面积累了十分珍贵的经验,中医将疾病变化时出现的危险信号称为败兆,如中医典籍记载: “戴眼反折”为太阳经终信号, “耳聋,百节皆纵,目睘绝系”为少阳经绝死兆。(《素问〃诊要经终论》)五脏绝其败兆显现于五官开窍处,如 “鼻如烟煤,肺气已绝”,鼻火扇为肺竭凶兆,阴竭阳脱的败兆以汗、喘、躁为信号,烦躁为阳脱先兆,汗出不止为阴竭凶兆,息高喘冒为孤阳欲绝死兆。形神相离常常是败兆,如 “破 脱肉,目匡陷,真脏见,目不见人,立死”。(《素问〃玉机真脏论》)面色由晦暗突然转为两颊红赤,如妆如丹,是阴阳离绝,阳气虚脱,孤阳升越的回光返照现象。 “视其目色,以知病之存亡也”。(《灵枢〃四时气》)临床上目陷、目黑、目暴盲皆为三大凶兆。耳缩、耳黑、耳凉及暴聋为四大凶兆。指纹的浮沉长implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 短和色泽变化可作为内脏气血盛衰信号,如指纹由合谷达风关、气关、命关直射指尖称透关射甲,提示病情危重。总之, “切脉动静而视精明,察五色,观五脏有余不足,六腑强弱,形之盛衰,以此参伍,决死生之分”。(《素问〃脉要精微论》)中医疾病预测学建立在中医脏象理论和经络学说基础上。脏象即 “脏居于内,而形见于外”,内脏有病可见于外,因此通过外在器官变化便能预知内脏的病理情况。由于脏象学说突出了人体内外相应、表里相关、上下互通、背腹呼应的特点,所以疾病的存在和发展不是孤立的。 一个器官有病,其他器官必然会受到波及而有所暴露,因而危重病的一些征兆是可以预测的。经络是脏腑的延伸,经气源于脏气,脏气通过经气互相通应。十二经三百六十五络,内联脏腑外络肢节,网络周身,无所不通。由于经络有高度感应性和传导性,因此体内疾病可以由经络表现出来。而且经络作为疾病传变的桥梁,作为疾病预测手段,往往最早反映体内的病理状况。经络运行气血,构成了中医疾病预测学的物质基础。 中医疾病预测学虽然是以定性观察为主,主观因素影响较大,但其对病情的判断是直觉的、动态的、整体的、宏观的。中医疾病预测学有悠久的历史,广泛地用于医疗实践活动中,在危重病救治中能快速地做出判断,无需借助高精尖设备。中医以直观法收集四诊信息,运用模糊数学概念,对信息的量模拟分级,按量级来判断价值。 3 建立中西医结合的危重病评价体系 现代中医学临床上常以咳、喘、痰、肿、瘀等症状缓解或消失来判断病情的危重程度,部分参考了西医诊断学指标。 2002年版的《中药新药临床研究指导原则》中也可见一些危重病的诊断标准及疗效评价,主要考虑临床症状的变化,所以implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 危重病的程度以患者的症状和体征为主进行客观评价是合理和可行的。但上述症状和体征等的观察,仍然是医师的观察结果,因此判断内容尚不够全面,也缺乏良好的可操作性。 纵观中医药学发展历史,中医临床实践一直重视患者自身及其与环境、社会的关系,体现整体观念、辨证观念,中医危重病的病情观察也多注重患者感觉、症状变化和改善。但是,为了适应现代医学对于危重病的评价,现代中医领域逐步采用西医的危重病评分系统,可能并不能全面反映中医药的临床治疗效果,甚至无法从根本上阐明中医对危重病治疗的整体概貌。要客观、全面地评价病情,除了应用西医APACHE评分外,中医危重病的临床评价也应是临床预测的主要方面,两者共同构成了危重病的总体评价和预测。因此,需要一种能将两种方法有机结合,使之优势互补,适合我国国情和医疗机构的新的危重病病情评定方法。 因此,根据中医理论、病因病机和临床体征,构建中医危重病评分系统的理论框架,通过反复临床调查、测评,对评分系统的信度、效度和反应度等特性进行考评,最终形成既符合现代医学测量学的要求又具有中医临床特点的危重病评分量表,以对危重病的病情、预后和临床疗效进行客观评价是可行和必要的。 更多文章龙腾小说 编辑,ltxswl 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为 P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative 急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 implementation of corrective tasks for the new problems found in a timely manner into the special rectification and rectification category. In-depth summary of good practices and good experience in educational practice, good around the typical, continue to promote the rectification, to prevent repeated rebound, use of the results of the activities, timely organization look back again. The theoretical results, continuously consolidate and deepen and expand educational practice to achieve the system results, practical results. Three, the main problems and rectification measures focus on rectification goals, determined to honor the commitment rectification measures to build long-term mechanism style construction bureau Party, improve the ideological style The construction and working level, according to the list of issues to sort it out, with overall requirements to carry out the mass line of educational activities, focus on the implementation of the rectification, enhance team ability to discover and solve their own problems, focus on building a political firm, pioneering and innovative, wholeheartedly for the people, strive for unity, harmony, strong collective leadership (a honest and clean.) there lack of global awareness and innovation problem in carrying out the democratic centralism of the party. The party will discuss the main points of the 2014 Bureau of safety production and internal functional components in the labor bureau held a bureau and executive, and discuss specific personnel in 2013, major capital spending No, strictly implement the decision procedures of "three major" matters "collective leadership, democratic centralism, individual consultations, the meeting decided the working principle of the tight loose, not very good to play the role of all members of the leadership team, in the global consultation is not enough, did not fully consider the actual situation of the individual, but by the executive sure, the lack of democracy in different opinions fully discussed and demonstrated. In relation to personal adjustment and the functional group work, individual party members and cadres are not good put forward their views and opinions, or dare to express their views, the crowd, the lack of global awareness and sense of innovation. Some leading cadres are too strong Adjust the local and local interests, the tendency to ignore the overall interests, focus on immediate interests and local interests, in the implementation of the decision and task, and even the existence of "do not want to do, want to do such a backlash and cope with the negative
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