手术及血管造影确诊的急性肠系膜上动脉栓塞43例临床分析  

The clinical analysis for 43 cases of acute superior mesenteric artery thrombosis confirmed by angiography and surgery

作　　者：刘文徽[1] 石卉[1] 廖亮[1] 吴本俨[1] 

机构地区：[1]解放军总医院南楼消化科,北京100853

出　　处：《中华内科杂志》2014年第5期375-379,共5页Chinese Journal of Internal Medicine

基　　金：解放军总医院临床科研扶持基金（2013FC-TSYS-1004）;军队保健专项科研课题（12BJZ31）

摘　　要：目的 探讨急性肠系膜上动脉栓塞（ASMAE）患者的临床特点及死亡相关危险因素.方法 对2002年6月-2012年6月解放军总医院确诊的43例ASMAE患者病历资料进行回顾性分析,并按预后情况分为生存组（28例）及死亡组（15例）,分析影响ASMAE预后的相关因素.结果 本组患者多具有动脉粥样硬化病变基础;临床主要表现为腹痛[100％ （43/43）]、恶心呕吐[55.8％（24/43）]、便血[32.6％ （14/43）]等症状;32例患者接受腹部CT检查,31例（96.9％）阳性.生存组体重减轻发生率明显高于死亡组[32.1％ （9/28）比6.7％（1/15）,P=0.001],logistic回归分析显示与慢性缺血有关的体重减轻是ASMAE患者生存的保护性因素（OR=0.75,P=0.038）.生存组腹膜刺激征及腹腔积液发生率均明显低于死亡组[7.1％ （2/28）比66.7％（10/15）,14.3％ （4/28）比73.3％ （11/15）,P值均＜0.05],两者是ASMAE死亡的独立危险因素（OR =8.51,P=0.014;OR=3.07,P=0.028）.死亡组患者肠系膜上动脉（SMA）主干栓塞的发生率高于生存组[93.3％（14/15）比60.7％ （17/28）,P=0.023],SMA主干栓塞是ASMAE死亡的独立危险因素（OR =5.05,P=0.039）.共18例患者接受了肠切除治疗,生存组的肠切除长度短于死亡组[（82.8土25.2）cm比（141.0±18.1）cm,P=0.017],发病至接受处理的时间短于死亡组[（44.8±29.7）h比（69.1±28.0）h,P=0.013].结论 慢性缺血基础上发生的ASMAE预后相对较好;腹膜刺激征、腹腔积液、SMA主干栓塞为ASMAE患者死亡的危险因素;肠切除长度及发病至处理时间可能与死亡相关.Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism （ASMAE）.Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012 were retrospectively analyzed.All patients were classified into the survival group （28 cases） and the death group （15 cases）according to the prognosis.The prognosis associated factors were further analyzed.Results The study group consisted of 31 men （72.1％）and 12 women （27.9％）,with average age of （63 ± 11） years.The majority patients with ASMAE in our study had history of atherosclerotic diseases.The main clinical manifestationsincluded abdominal pain [100％ （43/43）],nausea and vomitting [55.8％ （24/43）],hematochezia [32.6％ （14/43）].Abdominal CT scan was performed in 74.4％ （32/43） patients with a high positive result of 96.9％ （31/32）.Weight loss occurred more frequently in survival group than in death group [32.1％ （9/28） vs 6.7％ （1/15）,P =0.001].Moreover,weight loss has been shown as a protective factor for ASMAE survival （OR =0.75,P =0.038） by logistic analysis.Compared with the death group,the incidence of either peritoneal irritation sign or ascites was significantly lower in survival group [respectively 7.1％（2/28） vs 66.7％ （10/15）,14.3％ （4/28） vs 73.3％ （11/15）,P ＜0.05],which were two independent risk factors of mortality（OR =8.51,P =0.014 ; OR =3.07,P =0.028）.The incidence of main artery embolism of superior mesentery artery （SMA） in death group was higher than that in survival group [93.3％ （14/15） vs 60.7％ （17/28）,P =0.023].Main artery embolism of SMA was also an independent mortality risk factor of ASMAE patients （OR =5.05,P =0.039）.A total of 18 patients were treated with enterectomy.Intestine excision length was shorter in survival group than in death group [（82.8 ± 25.2） cm vs （141.0 ± 18.1）cm,P =0.017].Th

关 键 词：栓塞 肠系膜上动脉 死亡 生存 

分 类 号：R572.3[医药卫生—消化系统]