Baumgartner F, Klein S
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Am Surg. 1989 Nov;55(11):660-4.
Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
镰状细胞危象常表现为腹痛，可能类似腹腔内感染。为确定区分这些情况的参数，我们回顾性研究了53例患有腹痛的镰状细胞贫血患者（基因型SS占62%，SC占15%，SA占11%，S-其他占11%；男性占30%，女性占70%；平均年龄23岁）。57%的患者疼痛由血管阻塞性危象引起；23%有外科疾病，20%有非外科性泌尿生殖系统疾病。在外科疾病中，12例患者中有9例（95%）患有胆囊炎，12例患者中有4例（33%）患有急性阑尾炎（1例患者两者都有）。与已证实的外科疾病相比，30例患者中有15例（50%）的血管阻塞性危象疼痛是弥漫性的，且更常伴有如四肢和胸部等远处疼痛（30例中有23例[77%]，P小于0.005）。30例血管阻塞性危象患者中有21例（70%）的疼痛类似先前的危象，而12例有外科性腹痛的患者中有1例（8%）类似（P小于0.005）。50%的腹部血管阻塞性危象有诱发事件（尤其是上呼吸道感染），而外科性腹痛患者中这一比例为0%（P小于0.010）。97%的镰状细胞危象患者在48小时内通过补液和吸氧疼痛缓解，而外科性腹痛患者中这一比例为0%（P小于0.01）。（摘要截短于250字）
