老年缺血性结肠炎的特点及临床表现探讨

[摘要] 目的 分析老年人缺血性结肠炎的特点、临床表现及预后。方法 选择该院2013年1―12月43例缺血性结肠炎的老年患者作为老年组，21例60岁以下的缺血性结肠炎患者为对照组，比较两组临床表现包括症状、内镜表现、实验室主要指标及预后。 结果 老年组100%合并动脉硬化相关疾病，高血压、高脂血症、糖尿病的发生率均高于对照组，两种及以上基础疾病的发生数高于对照组，老年组Hb、ALB浓度低于对照组， CRP浓度高于对照组，两组比较差异有学意义（P0.05），2周后结肠镜复查，老年组病灶消失率为83.72%，对照组病灶消失率为90.48%，两组均无死亡病例，两组疗效比较差异无统计学意义（P>0.05）。 结论 老年缺血性结肠炎临床表现不典型，当出现腹痛、腹泻、便血时及时行结肠镜检查，有利于疾病的早期诊断，减少误诊，提高患者预后。

[关键词] 老年人；缺血性结肠炎；临床表现；预后

[中图分类号] R574.62 [文献标识码] A [文章编号] 1674-0742（2014）07（a）-0001-03

[Abstract] Objective To analyze the characteristics， clinical manifestations and prognosis of ischemic colitis in the elderly. Methods 43 cases of elderly patients with ischemic colitis admitted in our hospital from January， 2013 to December， 2013 were selected as the elderly group， and 21 cases of patients with ischemic colitis under 60 years old were selected as the control group. The clinical manifestations such as symptoms， endoscopic findings， laboratory main indicators and prognosis of two groups were compared. Results The incidences of 100% complicated by atherosclerosis-related diseases， hypertension， hyperlipidemia and diabetes of the elderly group were higher than those of the control group， the incidence of 2 or more kinds of diseases were higher than those of the control group； the concentration of Hb， ALB was less than that of the control group， while CRP concentration was higher than that of the control group， the differences were statistically significant（P0.05）. Conclusion The clinical manifestations of ischemic colitis in the elderly are atypical. Colonoscopy should be timely performed when the patients have the symptoms of abdominal pain， diarrhea and hematochezia， which is conducive to the early diagnosis of the disease， reducing misdiagnosis and improving the prognosis of the patients.

[Key words] Elderly persons； Ischemic colitis； Clinical manifestations； Prognosis

缺血性结肠炎（IC）是老年人的常见疾病，根据病变性质，分为血管性病变和非血管性病变。该病上世纪60年代由Marston提出并命名[1]，顾名思义，IC是一种独立性疾病，是多种因素导致肠道血供不足或回流受阻，从而继发肠壁缺血，组织坏死，是消化道出血的病因之一。早期诊断和治疗预后较好，但由于该病临床表现无特异性，轻型病例具有一过性特点，漏诊、误诊率较高，达60%以上，老年人是IC的高危人群，半数以上的老年患者由于漏诊、误诊而延误治疗，从而继发腹膜炎、结肠穿孔、坏疽、中毒性休克，甚至死亡[2]。为分析老年人缺血性结肠炎的特点、临床表现及预后，该研究2013年1―12月间通过老年组与青壮年缺血性结肠炎患者的临床表现、合并症特点及CRP等指标的比较，提高对老年人缺血性结肠炎的认识，减少误诊率对保障老年患者医疗安全具有积极的意义。报道如下。