急性肠系膜上动脉闭塞性疾病发生肠坏死的早期预测因素  

Early predictive factors for intestinal necrosis in acute superior mesenteric artery occlusive diseases

作　　者：刘大方[1] 郝小强 叶颖江[1] 谢启伟[1] 尹慕军[1] 杨晓东[1] 梁斌[1] 王杉[1] Liu Dafang Hao Xiaoqiang Ye Yingjiang Xie Oiwei Yin Mujun Yang Xiaodong Liang Bin Wang Shan(Department of Gastroenterological Surgery, Peking University People＇s Hospital, Beijing 100044, China)

机构地区：[1]北京大学人民医院胃肠外科,100044 [2]山西省晋中市第一人民医院普外科

出　　处：《中华普通外科杂志》2017年第4期301-305,共5页Chinese Journal of General Surgery

基　　金：北京市科技计划项目基金资助项目（1141107002514156）

摘　　要：目的探讨急性肠系膜上动脉闭塞性疾病患者发生肠管坏死的预测因素及其对于开腹探查术时机选择的意义。方法回顾性分析北京大学人民医院1995年7月至2015年6月间收治的29例肠系膜上动脉栓塞或血栓形成患者的临床资料。结果本组中12例患者出现肠坏死，与未出现肠坏死的17例患者相比预后不良（Х^2=14.867，P=0，000）。单因素分析显示，早期肠坏死的潜在性预测因素包括10个：D-二聚体≥600μg/L（Х^2=11．455，P=0．002）、INR≥1．2（Х^2=3．948，P=0．047）、pH值〈7．4（Х^2=8．191，P=0．004）、碱剩余〈-1．0mmol／L（Х^2=8．191，P=0．004）、血乳酸≥2．2mmol／L（Х^2=7．535，P=0．006）、血BUN≥6mmol／L（Х^2=10．076，P=0．002）、CK≥80U／L（Х^2=8．191，P=0．004）、LDH≥210U／L（Х^2=13．079，P=0．000）、AST≥25U／L（Х^2=10．076，P=0．002）、全身炎症反应综合征（Х^2=10．076，P=0．002）。多因素分析未发现急性肠系膜上动脉闭塞性疾病发生肠坏死的早期独立预测因素。结论发生肠坏死的急性肠系膜上动脉闭塞性疾病患者的预后不良：出现凝血异常、肝、肾功能异常、代谢性酸中毒以及全身炎症反应综合征时应警惕肠坏死的发生并争取尽早行手术探查。Objective To explore the early predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive disease and its significance for the decision of exploratory laparotomy. Methods This retrospective study enrolled 29 patients diagnosed with acute superior mesenteric artery embolism or thrombosis in Peking University People＇s Hospital between July 1995 and June 2015. Results 12 patients developed intestinal necrosis. Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis （Х^2= 14. 867, P = 0. 000 ）. In univariate analysis, the early predictive factors for intestinal necrosis were D-Dimer ≥ 600μg/L （Х^2 = 11. 455, P = 0.002）, INR≥1.2 （Х^2 =3.948,P =0.047）, pH values 〈7.4 （Х^2 = 8. 191,P =0.004）, BE 〈 - 1.0 mmol/L （Х^2= 8. 191, P = 0. 004）, blood lactate ≥2.2 mmol/L （Х^2 = 7. 535, P = 0. 006） , BUN 1〉 6 mmol/L （Х^2=10.076,P =0.002）, CK≥80 U/L （Х^2=8. 191,P =0.004）, LDH≥210 U/L （Х^2= 13. 079,P=0.000）, ASTI〉25 U/L （Х^2= 10.076,P= 0.002）, SIRS （Х^2 = 10.076,P =0.002）. Multivariate logistic regression analysis found no independent predictive factors of intestinal necrosis in patients with acute superior mesenterie arterial occlusive diseases. Conclusion Intestinal necrosis in acute mesenteric arterial occlusive diseases indicates a poor prognosis. Coagulation abnormalities, liver or kidney dysfunction, metabolic acidosis and SIRS necessitates an immediate exploration.

关 键 词：肠系膜血管闭塞 肠系膜上动脉 预测 肠坏死 

分 类 号：R572.3[医药卫生—消化系统]