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目的:探究夜间以上腹痛就诊急诊内科患者的病因分布特点,分析误诊原因。方法:把472例夜间(0:00～6:00时)在我院急诊内科以上腹痛就诊的患者(Ⅰ组),与同期随机抽查的其他时间(6:00～24:00时)发病就诊的230例上腹痛患者(Ⅱ组)作对比研究,分析疾病谱分布特点、首次疑似诊断正确率等。结果:Ⅰ组常见疾病为胆系结石或炎症(49.2%)、溃疡病(14.6%)、急性胃(肠)炎(10.6%)、急性阑尾炎(7.4%)等,Ⅱ组常见疾病为溃疡病(20.4%)、慢性胃炎(18.7%)、胆系结石或炎症(13.9%)、急性胃(肠)炎(13%)等。外科疾病比例,Ⅰ组61.2%,Ⅱ组30.4%,差异有统计学意义(P<0.05);其中Ⅰ组胆系结石或炎症比例达49.1%,大于Ⅱ组的13.9%,差异有统计学意义(P<0.05);首次疑似诊断正确率,Ⅰ组58.5%,Ⅱ组66.9%,两组间差异无统计学意义。结论:夜间以上腹痛就诊急诊内科患者中,外科胆道系统疾病多于内科的胃肠道疾病,非消化系统疾病也占一定比例,接诊人员应了解夜间上腹痛疾病谱特点,减少误诊。
Objective: To investigate the etiology and distribution of emergency medical patients with abdominal pain at night and to analyze the causes of misdiagnosis. Methods: A total of 472 patients (Group Ⅰ) who were treated with abdominal pain above the emergency department at our hospital from 0:00 to 6:00 at night (from 6:00 to 24:00) 230 cases of upper abdominal pain patients (group Ⅱ) for comparative study, analysis of the characteristics of the disease spectrum distribution, the first suspected diagnosis of correct rate. Results: The common diseases in group Ⅰ were gallstones or inflammation (49.2%), ulcer disease (14.6%), acute gastritis (10.6%) and acute appendicitis (7.4% (20.4%), chronic gastritis (18.7%), gallstones or inflammation (13.9%), acute stomach (13%) and so on. The proportion of surgical diseases was 61.2% in group Ⅰ and 30.4% in group Ⅱ, with a significant difference (P <0.05). The proportion of gallstone or inflammation in group Ⅰ was 49.1%, which was 13.9% of that in group Ⅱ, the difference was statistically significant (P <0.05). The accuracy of the first suspected diagnosis was 58.5% in group Ⅰ and 66.9% in group Ⅱ, with no significant difference between the two groups. CONCLUSIONS: Among the emergency medical patients with abdominal pain at night, the surgical biliary system diseases are more than the internal gastrointestinal diseases and the non-digestive system diseases also account for a certain proportion. The admissions personnel should understand the characteristics of the nighttime upper abdominal pain disease spectrum and reduce the misdiagnosis.