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我院1985年5月至1995年5月共收治小儿急性坏死性肠炎20例,其中男15例,女5例;年龄最小4个月、最大12岁。临床表现发热腹痛各18例,腹泻血便各17例,呕吐8例,腹胀及中毒症状各14例,腹部压痛19例,血白细胞>1.5×10~9/L4例。大便培养均阴性。由于本病起病方式及临床表现不一,有3例分别误诊为肠套叠、细菌性痢疾、或小儿腹泻。误诊原因:(1)认识不足,缺乏详细分析,如患儿以腹痛、呕吐、解粘液状血便起病,易误为肠套叠;对有发热、腹痛、腹泻、脱水、大便镜检有大量红白细胞时,就满足于细菌性痢疾的诊断;(2)忽视对全身情况的了解和局部体征的检查,如精神萎靡,面色苍白,大便有特殊气味,应注意对腹部肿块及肛门指诊等检查。对有突然发热、腹痛、腹泻、呕吐的患儿,伴全身中毒症状重,大便血水样,血白细胞增高,应连续作X线腹部平片检查;(3)腹腔穿刺有血性或脓性液体者,有助诊断。应尽早给抗菌素、激素、输血、纠正水电解质平衡等治疗;对疑有肠坏死、肠穿孔者应及早作手术治疗,切除坏死病灶,排除内毒索,减轻中毒症状。
From May 1985 to May 1995, our hospital admitted 20 children with acute necrotic enteritis, including 15 males and 5 females; the youngest was 4 months and the oldest was 12 years old. Clinical manifestations of abdominal pain in each of 18 cases of diarrhea bloody stool in each of 17 cases, vomiting in 8 cases, 14 cases of abdominal distension and poisoning symptoms, 19 cases of abdominal tenderness, white blood cells> 1.5 × 10 ~ 9 / L4 cases. Stool culture were negative. As the disease onset and clinical manifestations vary, three cases were misdiagnosed as intussusception, bacterial dysentery, or children with diarrhea. Causes of misdiagnosis: (1) lack of understanding, the lack of detailed analysis, such as children with abdominal pain, vomiting, mucus-like bloody stool onset, easily mistaken for intussusception; have fever, abdominal pain, diarrhea, dehydration, stool microscopy have a large number Red and white cells, to meet the diagnosis of bacillary dysentery; (2) ignore the understanding of the general condition and local signs of examination, such as apathetic, pale, stool has a special smell, should pay attention to the abdominal mass and anus, etc. an examination. For children with sudden fever, abdominal pain, diarrhea and vomiting, with symptoms of systemic poisoning, stool blood and watery white blood cells, should be continuous X-ray examination of abdominal plain film; (3) abdominal puncture with bloody or purulent liquid Those who help diagnose. As soon as possible to antibiotics, hormones, blood transfusion, water and electrolyte balance correction treatment; for suspected intestinal necrosis, intestinal perforation should be as early as possible surgical treatment, removal of necrotic lesions, ruled out drug lysis, reduce the symptoms of poisoning.