多期增强CT诊断急性活动性胃肠道出血临床案例分析  

Diagnosis of Acute Active Gastrointestinal Bleeding by Multi-phase Contrast-enhanced Computed Tomography:A Clinical Case Analysis

作　　者：丁玲 张玉忠 鄂林宁 DING Ling;ZHANG Yuzhong;E Linning(Department of Medical Imaging,Longhua District People's Hospital of Shenzhen,Guangdong,Shenzhen 518109,China)

机构地区：[1]广东省深圳市龙华区人民医院医学影像科,广东深圳518109

出　　处：《CT理论与应用研究（中英文）》2023年第6期807-814,共8页Computerized Tomography Theory and Applications

摘　　要：急性胃肠道出血(AGIB)临床较为常见并且需要快速诊断和采取有效治疗措施。多期增强CT可以快速诊断胃肠道活动性出血的位置和原因等关键信息,指导后续治疗的选择,使其成为评估AGIB的潜在一线工具。本文报告4例AGIB的病例,临床表现主要为呕血、黑便、活动后心慌、乏力、血压下降、意识不清、昏迷等,部分患者伴腹胀、腹痛、头晕、胸闷;实验室检查结果提示贫血和便潜血阳性。多期增强CT检查后准确定位消化道活动性出血灶。4例患者中有2例患者经治疗后症状明显好转,1例患者因病情危重转入上级医院治疗后因多器官衰竭死亡,1例患者合并淋巴瘤及多器官衰竭,后因失血性休克死亡。本文对多期增强CT在AGIB临床诊断中的价值进行讨论并文献综述,旨在总结AGIB多期增强CT的影像学特点,为AGIB的及时诊断提供可靠依据。Acute gastrointestinal bleeding(AGIB)is a common and serious condition that requires prompt diagnosis and effective treatment.Multi-phase contrast-enhanced computed tomography(CT)can rapidly identify the location and cause of active gastrointestinal bleeding,providing crucial information for subsequent treatment decisions,and has become a potential first-line tool for evaluating AGIB.In this report,we describe four cases of AGIB with clinical presentations of hematemesis and melena,accompanied by symptoms such as post-exertional palpitations,weakness,hypotension,confusion,and coma.Some patients also had abdominal distension,pain,dizziness,and chest tightness.The laboratory results showed anemia and positive fecal occult blood tests.Multi-phase contrast-enhanced CT allowed for the accurate localization of the active bleeding sites in the digestive tract.Among the four patients,two showed significant symptom improvement after treatment,one was transferred to a higher-level hospital due to critical illness and died from multiple organ failure,and one patient died from hemorrhagic shock due to lymphoma and multiple organ failure.This article discusses the value of multi-phase contrast�enhanced CT for the clinical diagnosis of AGIB and provides a literature review to summarize the imaging characteristics of AGIB on multi-phase contrast-enhanced CT to provide reliable evidence for the timely diagnosis of AGIB.

关 键 词：CT 急性活动性胃肠道出血 诊断 

分 类 号：R814[医药卫生—影像医学与核医学]