特大面积重度烧伤合并肠系膜上动脉综合征患者救治体会

Treatment of extra large area severe burne patient complicated with superior mesenteric artery syndrome

【目的】总结成功救治特大面积烧伤患者合并肠系膜上动脉综合征(superior mesenteric artery syndrome,SMAS)的临床经验。【方法】治疗1例95%总体表面积(Ⅲ°85%总体表面积)烧伤患者,在积极补液复苏、抗感染、纠正肾功能不全及维护机体水电解质酸碱平衡的基础上,于伤后5 d行四肢Ⅲ°创面切痂自体微粒皮大张异体皮移植术,伤后3周再行背、臀、四肢部残余创面清创,分期自体邮票皮+异种(猪)皮相间移植术。患者因反复呕吐、腹胀3 d,于伤后20 d经彩色多普勒超声检查确诊为肠系膜上动脉综合征,立即给予禁食、胃肠减压等措施,纤维胃镜下放置鼻肠管置入空肠,行肠内营养支持及静脉高营养维持。【结果】患者于伤后21 d呕吐、腹胀消失,肠系膜上动脉综合征明显好转。伤后38 d创面已基本愈合。【结论】彩色多普勒超声检查是诊断肠系膜上动脉综合征的有效措施,在积极处理烧伤创面,合理应用自体皮,同种异体皮、异种皮覆盖创面,鼻肠管置入空肠,行肠内营养支持及静脉高营养辅助治疗是防治肠系膜上动脉综合征的有效治疗措施。

[Objective] To summarize the treatment of extra large area severe patient complicated by superior mesenteric artery syndrome. [Methods] After aggressive anti-infection, improvement of renal dysfunction, microskin and allograft skin grafting were performed to one patient with extensive bums of 95TBSA% （mo 85%TBSA）. SMAS was diagnosed by color Doppler flow imaging, including vomiting, abdominal distension occurred on 20 days postburns. After fasting and gastrointestinal decompression, the intravenous and enteral nutrient support was applied via duodenal tube by endoscopy. [ Results] Symptoms of vomiting and abdominal distension of SMAS were disappeared on 21 days postbums. The wounds healed on 38 days post burns. [Conclusions] The color Doppler flow imaging is the optimal method to diagnosis on SMAS. A systemic treatment of strategy is needed to the successful treatment of major burns complicated by SMAS, such as aggressive wound management, sound allogenic or heterogenic skin grafting, the intravenous and enteral nutrient support by duodenal tube put by endoscopy.