基于动态评估策略的非典型急腹症早期识别体系构建与实践——甘肃省成县人民医院急诊外科单中心经验

Construction and Practice of Early Identification System of Atypical Acute Abdomen Based on Dynamic Evaluation Strategy—A Single-Center Experience from the Emergency Surgery Department of Chengxian People’s Hospital, Gansu Province

摘要: 目的：探讨基于“动态评估”理念的非典型急腹症早期识别体系在县级医院急诊外科的应用效果。方法：回顾性分析甘肃省成县人民医院急诊外科2024年6月至2026年6月收治的以急性腹痛为主诉、最终确诊为非典型急腹症(肠系膜缺血及腹内疝)的47例患者临床资料。以2025年6月启动动态评估体系为节点，分为对照组(2024年6月~2025年5月，n = 21)与观察组(2025年6月~2026年6月，n = 26)，比较两组确诊时间、肠坏死发生率、手术干预率及预后指标。结果：启动动态评估体系后，非典型急腹症平均确诊时间由(15.3 ± 6.8) h缩短至(7.1 ± 3.2) h (P < 0.01)，肠坏死发生率由47.6%降至19.2% (P < 0.05)，病死率由19.0%降至3.8% (P < 0.05)。CT增强检查率由19.0%提升至53.8% (P < 0.05)。结论：基于动态评估的非典型急腹症早期识别体系在县级医院切实可行，可显著缩短确诊时间、降低肠坏死发生率及病死率，值得在同类医院推广。

Abstract: Objective: To investigate the clinical application value of an early identification system based on the concept of “dynamic assessment” for atypical acute abdomen in the emergency surgery department of a county-level hospital. Methods: A retrospective analysis was conducted on the clinical data of 47 patients admitted to the Emergency Surgery Department of Chengxian People’s Hospital, Gansu Province, between June 2024 and June 2026, who presented with acute abdominal pain as the chief complaint and were ultimately diagnosed with atypical acute abdomen (mesenteric ischemia and internal hernia). Using the initiation of the dynamic assessment system in June 2025 as the cut-off point, patients were divided into a control group (June 2024~May 2025, n = 21) and an observation group (June 2025~June 2026, n = 26). The time to diagnosis, incidence of intestinal necrosis, surgical intervention rate, and prognostic indicators were compared between the two groups. Results: After the implementation of the dynamic assessment system, the mean time to diagnosis for atypical acute abdomen was shortened from (15.3 ± 6.8) h to (7.1 ± 3.2) h (P < 0.01); the incidence of intestinal necrosis decreased from 47.6% to 19.2% (P < 0.05); and the mortality rate decreased from 19.0% to 3.8% (P < 0.05). The rate of contrast-enhanced CT examination increased from 19.0% to 53.8% (P < 0.05). Conclusion: The early identification system for atypical acute abdomen based on dynamic assessment is feasible in county-level hospitals. It can significantly shorten the time to diagnosis and reduce the incidence of intestinal necrosis and mortality, and is therefore worthy of promotion in similar hospitals.