老年终末期肾衰竭合并缺血性肠炎临床分析

Clinical analysis of 36 elderly patients with end stage renal disease complicated with ischemic colitis

目的总结老年终末期肾衰竭合并缺血性肠炎患者的临床特点。方法回顾分析2000年1月至2010年2月收治的36例合并缺血性肠炎的终末期肾衰竭血液透析患者的临床资料。其中男17例,女19例,年龄60～91岁,平均77.5岁。结果本组终末期肾衰竭合并缺血性肠炎36例,占同期终末期肾衰竭患者的6.9%(36/520)。患者均以腹痛、血便为主要症状;白细胞为(26.4±8.2)×109/L,血红蛋白为(68±12)g/L,纤维蛋白原为(5.6±1.2)g/L,D-二聚体为(3.8±1.6)mg/L;B超检查无特异性;纤维结肠镜检查示病变区黏膜充血水肿、瘀斑、糜烂、黏膜下出血、血管网消失、肠腔狭窄;腹部CT示肠系膜上静脉增宽。予扩血管及活血化瘀治疗有效,34例2周内治愈,2例因拒绝治疗死亡。结论终末期肾衰竭血液透析患者缺血性肠炎发病率较高,症状无特异,容易误诊,内窥镜及腹部CT、血管造影是最主要的确诊手段,及早行扩血管及活血化瘀治疗可取得良好效果。

Objective To summarize the characteristics, prevalence and treatment of ischemic colitis in end-stage renal failure hemodialysis patients. Methods The clinical data of 36 patients with end-stage renal failure and hemodialysis complicated with ischemic enterocolitis in past 10 years were retrospective analyzed Patients. Results Ischemic colitis in the end-stage renal failure hemodialysis patients wase common. It presented as abdominal pain, bloody stool as the main symptoms and was diagnosed by endoscopy, abdominal CT or selective angiography examination. Vasodilator and medications for promoting blood circulation to remove blood stasis were the major therapies. Conclusion The prevalence of end-stage renal failure hemodialysis patients complicated with ischemic enterocolitis is high. Symptoms of this severe complication are no specific, so it is easy to be misdiagnosed. Endoscopy and abdominal CT or angiography examination are the most important means for early diagnosis. Vasodilator and medications promoting blood circulation to remove blood stasis are useful in getting favorable prognosis.