急性肠系膜缺血196例临床特点分析

Clinical characteristics of acute mesenteric ischemia: report of 196 cases

摘要:

目的 分析总结多家综合医院急性肠系膜缺血（AMI）患者的临床、实验室检查结果及转归特点，以提高对AMI患者诊断、治疗的认识。方法 对国内18家医院2011年1月至2013年12月期间住院治疗的196例AMI患者临床及辅助检查资料进行回顾性分析。结果 AMI患者中≤18岁占7.65%，19～59岁占50.00%，≥60岁占42.35%。男性多于女性（59.69% vs 40.31%，P＜0.05）。来医院就诊的症状按照例数由多到少依次为腹痛（164/196），呕吐（109/196），恶心（96/196），腹胀（78/196），合并肠梗阻（61/196），消化道出血（50/196），乏力（28/196），发热（27/196），腹泻（24/196）。实验室检查表现为D?二聚体异常（99/113）、凝血酶原时间异常（122/181）、白细胞异常升高（111/193）、大便潜血阳性（74/196）、低蛋白血症（105/196）。既往腹部手术史（60/196）、高血压（40/196）及心脑血管疾病（40/196）都是其高危因素。确诊前行腹部CT检查102例，超声检查共58例。外科手术治疗113例，介入治疗20例，单纯药物治疗63例。结论 AMI以男性为多，可发生在不同年龄人群，但非老年人所占比例较老年人偏多。就诊时的主要临床表现有腹痛、呕吐、恶心、腹胀、消化道出血、合并肠梗阻等。有腹部手术史、高血压及心脑血管疾病、糖尿病等危险因素的患者，应警惕AMI的可能。及时进行螺旋CT血管造影、腹部血管超声等检查有助于尽早明确诊断。

Abstract:

Objective To analyze and summarize the clinical and laboratory characteristics and prognosis of acute mesenteric ischemia (AMI) patients in order to improve AMI diagnosis and treatment. Methods Medical records of 196 patients with AMI diagnosed at 18 domestic hospitals from January 2011 to December 2013 were collected, reviewed and analyzed retrospectively. Results Among the total 196 cases, 50.00% of them were at the age ranging from 18 to 59 years, and 42.35% were older than 60 years. There were more male than female patients (59.69% vs 40.31%, P＜0.05). The most common symptoms were abdominal pain (164/196), vomiting (109/196), nausea (96/196), abdominal distension (78/196), intestinal obstruction (61/196), gastrointestinal bleeding (50/196), fatigue (28/196), fever (27/196), and diarrhea (24/196). The observed abnormal biochemical values included D-dimer (99/113), prothrombin time (122/181), elevated white blood cell count (111/118), positive occult test (74/196), and hypoproteinemia (105/196). The possible high risk factors were history of abdominal surgery (60/196), hypertension (40/196), and cardio-cerebrovascular disease (40/196). Before diagnosis, 102 cases received abdominal CT examination, and 58 received ultrasonography. There were 113 cases undergoing surgical treatment, 20 cases intervention therapy, and 63 cases drug treatment. Conclusion AMI is more common in males, at different age groups, but the proportion of non-elderly larger than the elderly. Its main manifestations are abdominal pain, vomiting, nausea, abdominal distension, gastrointestinal bleeding, and intestinal obstruction, etc. We should constantly pay attention to the patients with risk factors, such as history of abdominal surgery, hypertension, cardio-cerebrovascular disease and diabetes for the occurrence of AMI. Spiral CT angiography and abdominal ultrasonographic examinations should be performed as early as possible to diagnose the disease definitely.