摘要 目的 分析老年人自发性内脏破裂及穿孔的病种及分布,为老年人急诊诊治提供借鉴。 方法 总结我院老年人尸检中自发性内脏破裂及穿孔84例,重点复查尸检资料的病理诊断和死亡原因。 结果 老年组内脏破裂及穿孔较非老年人多见(11.0%及7.3%,P<0.01)。老年组84例中以心脏及动脉瘤破裂、肿瘤破裂、炎症溃疡穿孔多见,占84.5%。胸腔脏器破裂者,心脏及动脉瘤破裂和肝硬化食管静脉破裂出血占93.3%；腹腔脏器破裂者,肿瘤和胃十二指肠溃疡占76.9%。与非老年人比较,除肝癌、肝硬化食管静脉曲张破裂非老年人是老年人的1.7倍外,心脏及动脉瘤破裂、肿瘤破裂、胃十二指肠溃疡穿孔,则老年人分别是非老年人的6.8、2.0、13.0倍。 结论 老年人自发性内脏破裂及穿孔易发,其疾病的分布特点与老年人多发疾病的分布特点是一致的。在研究老年患者死因时,不但要注意原发疾病,还要积极预防脏器自发破裂及穿孔等严重并发症。

Abstract Objective Toimprove the diagnosis and treatment of emergency in elderly patient through analysis ofthe causes of visceral rupture and perforation. Methods The data of pathologic diagnoses of 84 autopsy cases of the elderlywith visceral rupture and perforation were reviewed, and the possible associations withthe cause of death were studied. Results The elderly with visceral rupture and perforation were more thanthe non-elderly group (11.0% vs 7.3%, P<0.01). Inthe 84 elderly cases, 84.5% had rupture of heart or aneurysm, tumor, and gastro-duodenalulcer perforation, 93.3% of the intra-thoracic rupture were that of heart or aneurysm aswell as hepatic-cirrhosis, 76.9% of the intra-abdominal rupture were caused by tumor andpeptic ulcer. In comparison of the two groups, the cases of rupture of heart or aneurysmin the elderly group were 6.8 times more than in non-elderly group. The cases with ruptureof tumor and perforation(including bleeding) of gastro-duodenal ulcer were 2.0 times and13.0 times more than in non-elderly respectively. However, for the hepatic cancer andcirrhosis, there were 1.7 times more in non-elderly than in elderly. Conclusions Thediseases causing spontaneous visceral rupture and perforation in the elderly were as sameas their original diseases. In treatment of the elderly patients, attention should be paidto prevent visceral rupture and perforation besides treating their original diseases.

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