摘要目的 探讨老年缺血性肠病患者的早期临床特点.方法 收集2011年1月至2016年6月在河南科技大学第一附属医院住院治疗的缺血性肠病患者 83例,按年龄分为老年组(≥60岁)和对照组(＜60岁),回顾性分析两组患者的临床特点、基础病史、检查方法及治疗等情况.结果 两组患者除年龄因素外,性别、职业、城乡来源等一般情况比较差异均无统计学意义(均P＞0.05).老年组急性肠系膜缺血(AMI)的发病率明显高于对照组[22.9%(11/48)比5.7%(2/35), χ2＝4.534, P＝0.033],对照组缺血性结肠炎(IC)的发病率高于老年组[94.3%(33/35)比70.8%(34/48), χ2＝7.154,P＝0.007].老年组误诊率明显高于对照组[58.3%(28/48)比34.3%(12/35), χ2＝4.688, P＝0.030].两组均以腹痛、腹泻、血便为主要表现,老年组以中等疼痛和隐痛为主,占75.0%(36/48),对照组以绞痛为主,占65.7%(23/35).老年组患者伴发高血压、冠心病、脑梗死的比例较对照组高[分别为70.8%(34/48)比25.7%(9/35),62.5%(30/48)比20.0%(7/35),16.7%(8/48)比0(0/35),χ2值分别为16.504、14.798、4.684,均P＜0.05].老年组接受结肠镜检查的患者比例低于对照组[52.1%(25/48)比94.3%(33/35),χ2＝17.127,P＝0.000].老年组内科治疗总有效率为90.2%(37/41),多为慢性肠系膜缺血和IC患者,而11例老年AMI患者内外科疗效均差,死亡5例.结论 老年缺血性肠病中AMI的发病率和死亡率较高,而CMI、IC一般预后良好.结合临床特点及时诊断,选择适宜的治疗,可提高其治愈率、降低死亡率.

abstractsObjective To analyze the clinical characteristics of ischemic bowel disease in elderly patients.Methods The clinical data of 83 patients with ischemic bowel disease, including 48 patients aged ≥60 years (elderly group ) and 35 patients aged ＜60 years ( control group ), admitted in our hospital from January 2011 to June 2016 were retrospectively analyzed.The clinical characteristics , underlying diseases, examination methods and treatment were compared between the two groups .Results There were no significant differences in gender , occupation, urban or rural origin between the two groups (P＞0.05).The incidence of acute mesenteric ischemia ( AMI) in elderly group was significantly higher than that in the control group [22.9%(11/48) vs.5.7%(2/35), χ2＝4.534, P ＝0.033];while the incidence of ischemic colitis (IC) in control group was higher than that in the elderly group [94.3%(33/35) vs. 70.8%(34/48), χ2＝7.154, P＝0.007].Elderly group was more prone to misdiagnosis as compared with the control group [58.3%(28/48) vs.34.3%(12/35), χ2＝4.688, P ＝0.030] .Abdominal pain, diarrhea and hematochezia were the most common clinical manifestations of the two groups .Moderate pain and dull pain were the main symptoms of the elderly group accounting for 75.0%(36/48), while colic was the main symptoms of the control group accounting for 65.7%(23/35).The proportion of elderly patients with hypertension, coronary heart disease and cerebral infarction was higher than that of the control group [70.8%(34/48)vs.25.7%(9/35),62.5%(30/48) vs.20.0%(7/35),16.7%(8/48) vs.0(0/35), χ2＝16.504,14.798,4.684,all P＜0.05].The number of patients receiving colonoscopic examination was lower in the elderly group than that in the control group [52.1%(25/48) vs.94.3%(33/35), χ2＝17.127, P＝0.000 ] .The overall effective rate of medical treatment for elderly patients was 90.2%(37/41), mostly of them were chronic mesentery ischemia (CMI) and IC patients; while 11 cases of AMI patients had poor outcomes of medical and surgical treatment including 5 fatal cases.Conclusions The incidence and mortality of AMI in elderly patients with ischemic bowel disease are higher , while CMI and IC have good prognosis.Timely diagnosis, appropriate treatment may improve the cure rate and reduce mortality for elderly patients with AMI.