中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
9期
753-756
,共4页
刘芳%江成功%冯雪茹%刘梅林
劉芳%江成功%馮雪茹%劉梅林
류방%강성공%풍설여%류매림
主动脉瓣狭窄%血管畸形%海德综合征
主動脈瓣狹窄%血管畸形%海德綜閤徵
주동맥판협착%혈관기형%해덕종합정
Aortic valve stenosis%Vascular malformation%Heyde's syndrome
目的 通过对主动脉瓣狭窄合并消化道出血病例的分析,提高对海德综合征的认识.方法 总结分析北京大学第一医院近10年共14例主动脉瓣狭窄合并消化道出血患者的临床资料及预后.结果 14例患者均为中、重度钙化性主动脉瓣狭窄合并消化道大出血,13例年龄≥65岁.13例行消化系统影像学检查,6例发现肠道血管畸形.11例重度主动脉瓣狭窄患者中6例行主动脉瓣置换术,术后未再发生消化道出血；5例采取保守治疗,2例猝死.结论 对原因不明的老年消化道出血患者应及时行超声心动图和消化道内镜检查,有助于海德综合征的早期诊治.主动脉瓣置换术是改善本病预后的根本方法.
目的 通過對主動脈瓣狹窄閤併消化道齣血病例的分析,提高對海德綜閤徵的認識.方法 總結分析北京大學第一醫院近10年共14例主動脈瓣狹窄閤併消化道齣血患者的臨床資料及預後.結果 14例患者均為中、重度鈣化性主動脈瓣狹窄閤併消化道大齣血,13例年齡≥65歲.13例行消化繫統影像學檢查,6例髮現腸道血管畸形.11例重度主動脈瓣狹窄患者中6例行主動脈瓣置換術,術後未再髮生消化道齣血；5例採取保守治療,2例猝死.結論 對原因不明的老年消化道齣血患者應及時行超聲心動圖和消化道內鏡檢查,有助于海德綜閤徵的早期診治.主動脈瓣置換術是改善本病預後的根本方法.
목적 통과대주동맥판협착합병소화도출혈병례적분석,제고대해덕종합정적인식.방법 총결분석북경대학제일의원근10년공14례주동맥판협착합병소화도출혈환자적림상자료급예후.결과 14례환자균위중、중도개화성주동맥판협착합병소화도대출혈,13례년령≥65세.13례행소화계통영상학검사,6례발현장도혈관기형.11례중도주동맥판협착환자중6례행주동맥판치환술,술후미재발생소화도출혈；5례채취보수치료,2례졸사.결론 대원인불명적노년소화도출혈환자응급시행초성심동도화소화도내경검사,유조우해덕종합정적조기진치.주동맥판치환술시개선본병예후적근본방법.
Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11％,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 ％,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P ＜0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR) successfully (6/11) and no recurrent gastrointestinal bleeding was ever found.Conservative treatment was performed in the other 5 patients with severe aortic valve stenosis (5/11) and resulted in sudden death in 2 patients (2/5).Conclusions Prompt echocardiography and gastrointestinal endoscopy should be performed in the elderly patients with obscure gastrointestinal bleeding to facilitate the early diagnosis and treatment of Heyde's syndrome.AVR is a fundamental procedure to improve the prognosis of Heyde's syndrome.
