以背痛為表現的致命性疾病的評估與處置

Evaluation And Management of Life-threatening Diseases Presenting As Back Pain

背痛在中年人當中很常見，也是一個隱藏許多致命性疾病的一種常見臨床症狀。對臨床醫師而言，快速的從造成背痛的疾病中辨別和排除急重症可以預防病患的病情惡化或病危。所以，我們著重在這些致命性疾病的鑑別診斷，包括急性心血管疾病、主動脈剝離、腹主動脈瘤、腎臟栓塞、脊椎壓迫性骨折、脊椎神經受損、癌症、脊椎神經感染、脊椎硬膜外膿瘍和急性腎臟發炎。完整的病史詢問和理學檢查是發現隱藏致命性疾病的重要關鍵。雖然現在對於背痛的病患，影像學檢查是很基本的檢查項目，但是常規使用影像學檢查併無法改善病況結果。當診斷確立後，儘早開始像是藥物治療、抗生素使用或手術可以減輕病情和死亡率。所以，我們回顧了幾份最新的有關於以背痛為表現的致命性疾病的文獻報告。

Back pain is common in older adults, and also a common clinical symptom with many potential etiologies of life-threatening disease. Back pain is common in older adults, and also a common clinical symptom of many life-threatening diseases. Immediate recognition and exclusion of critical disease that causes back pain is important to physicians in order to prevent deleterious effect or mortality. So, we focus on the differential diagnosis of life-threatening back pain including acute coronary syndrome, aortic dissection, abdominal aortic aneurysm, renal infarction, vertebral compression fracture, spinal cord injury, malignancy, spinal infection, spinal epidural abscess and acute pyelonephritis. Complete history taking and physical examination are the keys to discover the underlying life-threatening disease. Although image studies are the essential survey for patients with back pain, the routine use of image studies do not improve outcomes. When the diagnosis is established, early initial treatment such as medication administration, antibiotic treatment or surgical intervention can reduce the morbidity and mortality. So we review several current principles about the algorism of approaching to the life-threatening disease presenting as back pain.