52例急性肠系膜缺血性疾病的临床研究分析  

The Clinical Analysis of 52 Patients with Acute Mesenteric Ischemia

作　　者：冯小鹏[1] 叶自力[1] 张雅斯 

机构地区：[1]广东省惠州市第一人民医院急诊内科,516003

出　　处：《岭南急诊医学杂志》2017年第3期262-265,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省惠州市科学技术局基金(2014Y050)

摘　　要：目的:预测急性肠系膜缺血性疾病的不良结局的危险因素。方法:收集惠州市第一人民医院2010年1月至2016年5月经血管造影或病理确诊急性肠系膜缺血性疾病52例患者的临床和实验室数据。结果:肠系膜动脉栓塞或血栓形成、肠系膜静脉血栓形成和非阻塞性肠系膜缺血占急性肠系膜缺血性疾病的病因分别为32例(62.5%),14例(27%),和6例(10.5%)。腹痛是最常见的症状有48例(92.1%)、腹膜炎46例(86.7%)和休克12例(21.5%)。腹部CT血管造影42例(81%)。大多数患者进行了手术,6例(12%)患者进行了第二次手术,死亡率为40.3%。死亡的主要原因为多器官衰竭(42%)。结论:使用抗血小板药物及地高辛,症状持续到手术前的时间,存在休克,严重酸中毒和再手术可能增加患者的死亡率;CT血管造影、外科早期干预和肠外营养支持可能改善患者生存。Objective：To define risk factors that predict the adverse outcome of Acute mesenteric ischemia（AMI）. Methods：52 patients with hospital records and clinical data of undergoing surgical intervention for AMI from January 2010 to May 2016 were reviewed and clinical outcomes as well as factors influencing mortality were analyzed.Results：Mesenteric arterial thrombosis,arterial embolism and nonocclusive mesenteric is chemia（NOMI）were the cause of AMI in 32（62.5%）,14（27%）,and 6 patients（10.5%）,respectively. Abdominal pain was the most common presenting symptom（92.1%）. Peritonitis was observed in 46 patients（86.7%）and 12 patients（21.5%）were in shock.Abdominal CT angiography was performed in 42 patients（81%）. The most patients were operated and 6（12%）patients underwent a second-look operation. Themortality was 40.3%. Mortality was mainly due to multiorgan failure（42%）.Conclusion：Use of digoxine and antiplatelet drugs,duration of the symptoms until before surgery,existence of shock,low levels of the p H and bicarbonate and relaparotomy were found to be negative predictors of the perioperative mortality.The use of total parenteral nutrition and CT angiography was found to be a protective factor against mortality.

关 键 词：急性肠系膜血管缺血 诊断 临床管理 

分 类 号：R657.2[医药卫生—外科学]