摘要
为探讨急性重症肛周感染（SAD的发病特征、救治原则和临床疗效，回顾性分析2009年8月～2015年12月入住我院的31例SAI患者和29例同期急性普通肛周感染患者的临床资料。将31例急性SAI患者作为观察组，29例同期急性普通肛周感染患者（60岁以上）作为对照组，对两组患者的血清降钙素原（PCT）、白细胞计数、体温以及临床疗效和随访结局等进行对照与分析。结果显示，观察组31例，30d院内病死19例（病死率61．3％，19／31），康复6例，好转4例，转慢性重症2例（有效率38．7％，12／31）；对照组29例，30d内无死亡，康复25例，好转4例（有效率100％）。2组比较差异有统计学意义（P〈0．01）。对照组患者脓腔深、脓液量多（60～90mL）者，如骨盆直肠间隙脓肿，术前会出现体温升高（37℃～39℃），白细胞计数显著升高，并伴有里急后重、疲乏无力等症状。脓液量少、脓腔浅者，如皮下脓肿，术前多数体温正常（37℃以下），白细胞计数正常或略高，局部红、肿、热、痛明显，术后均恢复正常。急性普通肛周感染患者有无发热及白细胞计数升高是判断高位脓肿、低位脓肿及脓液多少的重要指标，不能以患者肛周疼痛程度来鉴别。观察组患者除表现白细胞计数异常（升高或降低）外，体温保持较高（38℃）或有波动者比体温较低（37℃以下）或无波动者预后好；体质较好或较胖者比体质较弱或较瘦者预后好；病情较急较单纯或病程较短者比病情较重较复杂或病程较长者预后好（P〈0．01或P〈0．05）。观察组患者因基础疾病不同，复查PCT水平随病情变化出现波动，当PCT〉10ng／mL时患者预后较差。结果表明，急性重症肛周感染发病率增多，病死率较高，其影响持久，应当重视。
This study was to explore the onset characteristics,treatment rules,clinical efficacy of acute severe perianal infection （SAD analyzed retrospectively data of 31 cases with SAI and 29 cases （age）60） with general acute perianal infection at the same time admitted in authors＇ hospital from August 2009 to December 2015; regarded 31 cases with SAI as observation group and 29 cases （age）60） with general acute perianal infection as control one~ compared and analyzed their serum procalcitonin （PCT）, white blood cell count （WBC-C）,body temperature,clinical efficacy and follow-up results between the two groups. As results,in 31 cases of observation group,there were 19 cases died of the disease within 30 d in the hospital （fatality rate 61.3G, 19/31）, 6 recovered, 4 improved, 2 turned to chronic severe type （effective rate 38.7G ,12/31） ; in 29 cases of control group,there was no death within 30 d,25 recovered,4 improved （ef- fective rate 100 G）.There was statistical significance between.the two groups（ P %0.01）.The patients with deeper pus cavity and much pus （60-90 mL） of control group,such as pelvirectal space abscess,were higher in body temperature（ 37℃-39 ℃） and in WBC-C before operation accompanied with such complications as tenesmus and exhaustion,etc.Most of patients with low pus cavity and less pus （such as subcutaneous abscess） were normal in body temperature （below 37 ℃）,normal or slightly high in WBC-C and obvious in local red , swell , hot , pain; all patients got normal after operation. With or without fever and WBC-C higher were important indicators of judging high ＆ low abscess and pus volume; it can not be identified according to the perianal pain degree of patients. Except for the abnormal WBC-C （higher or lower） ,the patients who kept higher（above 38℃） or fluctuated body temperature, who had a better constitution or were fat,who had acute ＆ simple condition of disease and shorter course of disease had a better prognosis compared with those who kept lower（below 37 ℃） or no fluctuated body temperature,who had weak constitution or Were thin,who had severe ~ complicated condition of disease and longer course of disease （ P〈0.01 or P〈0. 05）.Due to the difference of basic disease in patients of observation group,the reviewed PCT level fluctuated with the changes of disease.When the PCT〉10 ng/mL,the prognosis of patients was worse.In conclusion,SAI has more occurrence rate, higher fatality rate,lasting influence.
出处
《中国肛肠病杂志》
2016年第9期11-14,共4页
Chinese Journal of Coloproctology
