CAJ | 학술논문

目的探讨急性肠系膜上动脉栓塞(ASMAE)患者的临床特点及死亡相关危险因素.方法对2002年6月-2012年6月解放军总医院确诊的43例ASMAE患者病历资料进行回顾性分析,并按预后情况分为生存组(28例)及死亡组(15例),分析影响ASMAE预后的相关因素.结果本组患者多具有动脉粥样硬化病变基础;临床主要表现为腹痛[100％ (43/43)]、恶心呕吐[55.8％(24/43)]、便血[32.6％ (14/43)]等症状;32例患者接受腹部CT检查,31例(96.9％)阳性.生存组体重减轻发生率明显高于死亡组[32.1％ (9/28)比6.7％(1/15),P=0.001],logistic回归分析显示与慢性缺血有关的体重减轻是ASMAE患者生存的保护性因素(OR=0.75,P=0.038).生存组腹膜刺激征及腹腔积液发生率均明显低于死亡组[7.1％ (2/28)比66.7％(10/15),14.3％ (4/28)比73.3％ (11/15),P值均＜0.05],两者是ASMAE死亡的独立危险因素(OR =8.51,P=0.014;OR=3.07,P=0.028).死亡组患者肠系膜上动脉(SMA)主干栓塞的发生率高于生存组[93.3％(14/15)比60.7％ (17/28),P=0.023],SMA主干栓塞是ASMAE死亡的独立危险因素(OR =5.05,P=0.039).共18例患者接受了肠切除治疗,生存组的肠切除长度短于死亡组[(82.8土25.2)cm比(141.0±18.1)cm,P=0.017],发病至接受处理的时间短于死亡组[(44.8±29.7)h比(69.1±28.0)h,P=0.013].结论慢性缺血基础上发生的ASMAE预后相对较好;腹膜刺激征、腹腔积液、SMA主干栓塞为ASMAE患者死亡的危险因素;肠切除长度及发病至处理时间可能与死亡相关.
목적 탐토급성장계막상동맥전새(ASMAE)환자적림상특점급사망상관위험인소.방법 대2002년6월-2012년6월해방군총의원학진적43례ASMAE환자병력자료진행회고성분석,병안예후정황분위생존조(28례)급사망조(15례),분석영향ASMAE예후적상관인소.결과 본조환자다구유동맥죽양경화병변기출;림상주요표현위복통[100％ (43/43)]、악심구토[55.8％(24/43)]、편혈[32.6％ (14/43)]등증상;32례환자접수복부CT검사,31례(96.9％)양성.생존조체중감경발생솔명현고우사망조[32.1％ (9/28)비6.7％(1/15),P=0.001],logistic회귀분석현시여만성결혈유관적체중감경시ASMAE환자생존적보호성인소(OR=0.75,P=0.038).생존조복막자격정급복강적액발생솔균명현저우사망조[7.1％ (2/28)비66.7％(10/15),14.3％ (4/28)비73.3％ (11/15),P치균＜0.05],량자시ASMAE사망적독립위험인소(OR =8.51,P=0.014;OR=3.07,P=0.028).사망조환자장계막상동맥(SMA)주간전새적발생솔고우생존조[93.3％(14/15)비60.7％ (17/28),P=0.023],SMA주간전새시ASMAE사망적독립위험인소(OR =5.05,P=0.039).공18례환자접수료장절제치료,생존조적장절제장도단우사망조[(82.8토25.2)cm비(141.0±18.1)cm,P=0.017],발병지접수처리적시간단우사망조[(44.8±29.7)h비(69.1±28.0)h,P=0.013].결론 만성결혈기출상발생적ASMAE예후상대교호;복막자격정、복강적액、SMA주간전새위ASMAE환자사망적위험인소;장절제장도급발병지처리시간가능여사망상관.
Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism (ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012 were retrospectively analyzed.All patients were classified into the survival group (28 cases) and the death group (15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study group consisted of 31 men (72.1％)and 12 women (27.9％),with average age of (63 ± 11) years.The majority patients with ASMAE in our study had history of atherosclerotic diseases.The main clinical manifestationsincluded abdominal pain [100％ (43/43)],nausea and vomitting [55.8％ (24/43)],hematochezia [32.6％ (14/43)].Abdominal CT scan was performed in 74.4％ (32/43) patients with a high positive result of 96.9％ (31/32).Weight loss occurred more frequently in survival group than in death group [32.1％ (9/28) vs 6.7％ (1/15),P =0.001].Moreover,weight loss has been shown as a protective factor for ASMAE survival (OR =0.75,P =0.038) by logistic analysis.Compared with the death group,the incidence of either peritoneal irritation sign or ascites was significantly lower in survival group [respectively 7.1％(2/28) vs 66.7％ (10/15),14.3％ (4/28) vs 73.3％ (11/15),P ＜0.05],which were two independent risk factors of mortality(OR =8.51,P =0.014 ; OR =3.07,P =0.028).The incidence of main artery embolism of superior mesentery artery (SMA) in death group was higher than that in survival group [93.3％ (14/15) vs 60.7％ (17/28),P =0.023].Main artery embolism of SMA was also an independent mortality risk factor of ASMAE patients (OR =5.05,P =0.039).A total of 18 patients were treated with enterectomy.Intestine excision length was shorter in survival group than in death group [(82.8 ± 25.2) cm vs (141.0 ± 18.1)cm,P =0.017].The time from onset to operation in survival group was shorter than that in death group [(44.8 ±29.7) h vs (69.1 ±28.0) h,P =0.013].Conclusions Patients with ASMAE based on chronic ischemia have a relative good prognosis for survival.Peritoneal irritation sign,ascites and main artery embolism of SMA were independent risk factors for death in ASMAE.Intestine excision length and the interval from onset to operation may affect the mortality of ASMAE patients.