纪忠, 王星, 梁朋真, 谢伟, 宋琦, 窦贺贺, 杜召辉, 郑传明. 急性肠系膜缺血疾病诊治及预后影响因素研究[J]. 蚌埠医学院学报, 2023, 48(10): 1361-1365. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.007
    引用本文: 纪忠, 王星, 梁朋真, 谢伟, 宋琦, 窦贺贺, 杜召辉, 郑传明. 急性肠系膜缺血疾病诊治及预后影响因素研究[J]. 蚌埠医学院学报, 2023, 48(10): 1361-1365. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.007
    JI Zhong, WANG Xing, LIANG Peng-zhen, XIE Wei, SONG Qi, DOU He-he, DU Zhao-hui, ZHENG Chuan-ming. Study on the diagnosis, treatment, and influencing factors of prognosis in acute mesenteric ischemia disease[J]. Journal of Bengbu Medical College, 2023, 48(10): 1361-1365. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.007
    Citation: JI Zhong, WANG Xing, LIANG Peng-zhen, XIE Wei, SONG Qi, DOU He-he, DU Zhao-hui, ZHENG Chuan-ming. Study on the diagnosis, treatment, and influencing factors of prognosis in acute mesenteric ischemia disease[J]. Journal of Bengbu Medical College, 2023, 48(10): 1361-1365. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.007

    急性肠系膜缺血疾病诊治及预后影响因素研究

    Study on the diagnosis, treatment, and influencing factors of prognosis in acute mesenteric ischemia disease

    • 摘要:
      目的探讨早期诊断急性肠系膜缺血(AMI)的方法、改善疗效的措施和影响预后的危险因素。
      方法选择139例急性闭塞性肠系膜缺血病人作为研究对象,根据预后将其分为治愈组(104例)和病死组(35例),对其发病特点、诊断方法、治疗效果及预后转归等临床资料进行回顾性分析。
      结果本研究139例病人中40例确诊为肠系膜动脉栓塞,75例肠系膜静脉血栓形成,24例肠系膜动脉血栓形成。其中行CTA/CTV检查者18例,15例可直接确诊为AMI,敏感率为83.33%;行数字减影血管造影(DSA)检查者2例,均确诊为AMI。103例病人接受了手术治疗,其中26例术后病死, 术后病死率25.24%;34例病人行保守治疗,病死9例, 保守治疗后病死率26.47%;接受介入治疗的2例病人均治愈;139例病人总体病死率为25.18%(35/139)。对影响预后的因素进行分析,结果显示年龄增加(OR=1.089, 95%CI: 1.004~1.182)、C反应蛋白水平升高(OR=1.015, 95%CI: 1.004~1.026)、乳酸水平升高(OR=4.302,95%CI: 2.276~8.132)均是AMI病人病死的独立危险因素。
      结论CTA/CTV、DSA检查有助于AMI早期明确诊断;包括手术、保守治疗、介入在内的针对性治疗以及综合治疗十分重要,对于符合条件的病人早期介入治疗能够提高生存率;年龄增加、C反应蛋白和乳酸水平的升高是预测AMI预后转归不良的重要因素。

       

      Abstract:
      ObjectiveTo investigate early detection methods for acute mesenteric ischemia (AMI), measures to improve efficacy, and risk factors affecting prognosis.
      MethodsA total of 139 patients with acute occlusive mesenteric ischemia were selected as the study subjects, and divided into cure group (n=104) and death group (n=35) based on prognosis.Their clinical data such as onset characteristics, diagnostic methods, treatment effects, and prognosis were retrospectively analyzed.
      ResultsAmong the 139 patients in this study, 40 cases were diagnosed with mesenteric artery embolism, 75 cases with mesenteric vein thrombosis, and 24 cases with mesenteric artery thrombosis.Among them, 18 cases underwent CTA/CTV examination, and 15 cases were directly diagnosed with AMI, with a sensitivity rate of 83.33%; 2 cases underwent digital subtraction angiography (DSA) examination, both were diagnosed with AMI.One hundred and three patients underwent surgical treatment, of which 26 cases died postoperatively, with a postoperative mortality rate of 25.24%; 34 patients underwent conservative treatment, of which 9 cases died, and the mortality rate after conservative treatment was 26.47%;2 patients undergoing intervention treatment were cured; the overall mortality rate of 139 patients was 25.18% (35/139).The influencing factors of prognosis were analyzed, and the results showed that increased age (OR=1.089, 95%CI: 1.004-1.182), elevated C-reactive protein levels (OR=1.015, 95%CI: 1.004-1.026), and elevated lactate levels(OR=4.302, 95%CI: 2.276-8.132) were all independent risk factors for death in AMI patients.
      ConclusionsCTA/CTV and DSA examinations are helpful for the early diagnosis of AMI.Targeted treatment including surgery, conservative treatment, and intervention therapy, as well as comprehensive treatment are very important.Early intervention therapy can improve survival rates for eligible patients.Increased age and elevated levels of C-reactive protein and lactate are important factors in predicting poor prognosis of AMI.

       

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