摘要
目的 分析临床极重的危重型溃疡性结肠炎 (UC)的诊断、治疗和预后。方法 搜集近 18年UC ,参考国外分型标准 ,拟订诊断标准 ,分出危重型 :①血性腹泻≥ 9次 /d ;②体温≥ 38°C ;③脉搏90次 /min以上 ;④血红蛋白 <90 g/L ;⑤血浆白蛋白≤ 30 g/L ;⑥明显营养障碍或严重中毒症状。具备 3/ 6条属危重型。结果 40例重症UC中危重型 2 7例。腹泻、便血、体重下降、发热、贫血频率分别为 10 0 %、10 0 %、92 %、82 %及 82 %。均为全结肠或广泛性结肠炎。并发休克 3例 ,肠穿孔 1例。 2 4例皮质激素治疗 ,最终手术 9例。 3例死亡。结论 危重型属UC重中之重 ,预后差 ,需特别监护、强化内科治疗 。
Objective To analyze the diagnosis, therapy and prognosis of the most severe type ulcerative colitis or critical ulcerative colitis. Methods Forty cases of severe ulcerative colitis in recent 18 years in our hospital were reviewed. Based on the criteria from literatures, a self generated criterion was used to identify the critical ulcerative colitis, i.e.: ① bloody stool≥9 times/d;② body temperature≥38°C;③ pulse rate≥90 beats/min;④ Hb<90 g/L;⑤ plasma albumin≤30 g/L;⑥ obvious malnutrition or severe toxic symptoms. The diagnosis was established when at least 3 of the 6 items existed, the treatment strategies and prognosis also reviewed. Results Twenty seven of the severe cases were included. Male∶female= 1.5∶1. Average course was 39.2 months. Seventeen cases were chronic relapse type, 7 cases were chronic persistent type and 3 fulminant type. Diarrhea, bloody stool, loss of body weight, fever, anemia accounted for 100%, 100%, 92%, 82% and 82% respectively. All were pancolitis or extensive colitis. Complications: Disorders of water and electrolytes 8 cases, shock with severe hematochezia and infection 3 cases, colon perforation and pulmonary edema 1 case each. Twenty four cases were treated with corticosteroid, among them steroids were used intravenously in 13 cases. Two cases were treated with chinese traditional medicine. In 13 cases blood transfusion were given, 5 cases were treated surgically. Outcome: 19 cases recovered after medical treatment, 4 cases got remission after operation, 1 case went home without significant improvement after 10 days' hospitalization, 3 patients died. After 1～18 years follow up, 4 cases were operated on, 8 cases were still in chronic relapse status. Conclusions Critical type is the most severe type of ulcerative colitis, which is with poor prognosis. On admittion, therefore, patients of ulcerative colitis should be clasified immediately according to their severity. The critical type should be specially supervised and treated intensively based on Oxford intensive 5 days' management. If there is no effect within 1 week, emergent operation should be considered.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2001年第4期201-204,共4页
Chinese Journal of Digestion
关键词
溃疡性结肠炎
危重型
诊断
治疗
转归
Ulcerative colitis
Critical
Diagnosis
Therapy
Prognosis
