心脏瓣膜置换术后合并缺血性肠病13例临床分析  

Analysis of clinical features on 13 cases of ischemic bowel disease after mechanical heart valve replacement

作　　者：尚亮[1] 左利平[2] 闫媛[2] 庄坤[2] 

机构地区：[1]陕西省人民医院老年病科,陕西西安710068 [2]西安市中心医院消化科

出　　处：《胃肠病学和肝病学杂志》2016年第12期1436-1439,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析心脏瓣膜置换术（mechanical heart valve replacement，MHVR）后并发缺血性肠病的病例资料，提高对该病的认识和临床诊治水平。方法回顾性分析13例缺血性肠病患者的临床资料、病史特点及各项辅助检查。结果13例患者病史中均有MHVR，术后于不同时间出现腹痛、便血等临床症状。PT-INR比值为1．3～1．78，D-二聚体均升高，行结肠镜检查发现结肠节段性黏膜充血、糜烂、溃疡。经内科对症治疗后。12例恢复良好，1例行外科剖腹探查术，切除部分坏死小肠。结论对于曾行MH-VR，术后低强度抗凝治疗的患者，突然出现腹痛、便血，应考虑缺血性肠病的可能，尽早进行相关检查，明确诊断，指导治疗。Objective To analyze the clinical features of patients with ischemic bowel disease after mechanical heart valve replacement （MHVR） , and raise the diagnosis and treatment of it. Methods A total of 13 patients were analyzed respectively on the clinical data, history characteristics and assistant examination. Results All of the 13 patients who had history of MHYR showed abdominal pain, bloody stool and other symptoms in different time after surgery. All the patients received low intensity anticoagulant treatment with warfarin with the PT-INR maintained from 1.3 to 1.78, and D-dimer elevated. Colon endoscopy with mucosa hyperemia, erosion, ulceration and other major non-specific perform- ance. Medical treatment was effective for 12 cases, surgical treatment in 1 case, postoperative recovered well. Conclu- sion Patients with unexplained abdominal pain and blood sign after MHVR should consider ischemic bowel disease, early detection and diagnosis will contribute to improving its treatment and prognosis.

关 键 词：心脏瓣膜置换术 缺血性肠病 早期诊断 

分 类 号：R574[医药卫生—消化系统]