肌酸激酶及CT血管造影检查评估肠系膜上动脉栓塞的短期预后  

Creatine kinase and computed tomography angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism

作　　者：吕和平[1] 倪海真[1] 黄景勇[1] 陈祥建[2] 虞冠锋[1] 

机构地区：[1]温州医科大学附属第一医院血管外科,325000 [2]温州医科大学附属第一医院腔镜外科,325000

出　　处：《中华消化外科杂志》2016年第8期840-844,共5页Chinese Journal of Digestive Surgery

基　　金：浙江省自然科学基金（LY16H160048）

摘　　要：目的探讨肌酸激酶及CT血管造影检查评估肠系膜上动脉栓塞短期预后的价值。方法采用回顾性横断面研究方法。收集2008年1月至2015年10月温州医科大学附属第一医院收治的26例肠系膜上动脉栓塞患者的临床资料。患者行血清学检查和CT血管造影检查。依据检查结果分别行药物保守治疗和外科手术治疗。观察指标：（1）临床特征。（2）血清学指标检测结果。（3）CT血管造影检查结果：①肠系膜上动脉栓塞位置（主干、非主干）以及远端分支显影情况；②间接征象如肠壁增厚，肠管扩张合并积液、积气，肠壁积气。（4）治疗及预后。正态分布的计量资料以冤±S表示，多组间比较采用单因素方差分析。偏态分布的计量资料以肘（范围）表示，采用Kruskal-Wallis秩和检验，两两比较采用Nemenyi法检验。结果（1）临床特征：26例肠系膜上动脉栓塞患者中，肠缺血6例，部分肠坏死8例，长段肠坏死12例（其中术后短肠综合征5例、全小肠坏死及部分结肠坏死7例）。6例肠缺血患者，确诊前症状持续时间为（1．7±0．8）d。8例部分肠坏死患者，确诊前症状持续时间为（2．1±1．1）d。12例长段肠坏死患者，确诊前症状持续时间为（1．5±0．7）d，3者比较，差异无统计学意义（F=1．27，P〉0．05）。（2）血清学指标检测结果：肠缺血、部分肠坏死、长段肠坏死患者血清肌酸激酶水平分别为68U／L（50～86U／L）、98U／L（54～244U／L）、300U／L（40～873U／L），3者比较，差异有统计学意义（H=7．32，P〈0．05）。肠缺血患者与长段肠坏死患者比较，差异有统计学意义（H=7．21，P〈0．05）。部分肠坏死患者分别与肠缺血、长段肠坏死患者比较，差异均无统计学意义（H=1．53，2．07，P〉0．05）。（3）CT血管造影检查结果：①肠系膜上动脉主干栓塞或非主干栓塞、远端分�Objective To investigate the value of creatine kinase and computed tomography （CT） angio- graphy to evaluate short-term prognosis of patients with superior mesenterie artery embolism （SMAE）. Methods The retrospective cross-sectional study was adopted. The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected. The patients received serologic examination and CT angiography firstly, and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations. Observation indices ： （ 1 ） clinical features, （2） serum indicators results, （3） CT angiography results ： （1） location （main stem and non-main stem） of SMAE and development of distal branches of superior mesenteric artery （SMA）, （2） indirect signs, such as bowel wall thickening, bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis, （4） therapy and prognosis. Measurement data with normal distribution were presented as x ± s, comparisons among groups were analyzed by one-way ANOVA. Measurement data with skewed distribution were presented as M （range） and analyzed by the Kruskal-Wallis rank sum test, and pairwise comparison was done using the Nemenyi test. Results （ 1 ） Clinical features： of 26 patients with SMAE, 6 patients had intestinal ischemia, 8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis （postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients）. Duration of symptoms before diagnosis was （ 1.7 ± 0. 8 ） days in 6 patients with intestinal ischemia and （2. 1 ± 1.1 ） days in 8 patients with partial intestinal necrosis and （ 1.5 ± 0.7 ） days in 12 patients with long segmental intestinal necrosis, with no statistically significant difference （ F = 1.27, P 〉

关 键 词：肠系膜上动脉栓塞 肌酸激酶 计算机体层成像 

分 类 号：R657.2[医药卫生—外科学]