急性非闭塞性肠系膜缺血一例报道并文献复习

Acute Non-occlusive Mesenteric Ischemia:A Case Study and Literature Review

急性非闭塞性肠系膜缺血(NOMI)是一种临床病死率高的罕见病,早期症状和体征缺乏特异性。B超、CT检查有助于诊断,肠系膜血管造影是诊断本病的金标准。治疗上首选扩血管药物及抗凝治疗,怀疑急腹症者可考虑手术探查。本文报道了我院收治的1例NOMI患者,其以消化道出血起病,后出现腹痛,经CT血管造影检查确诊。经胃肠减压、抗感染、止血、吸氧、罂粟碱改善肠道血运等积极治疗后症状有一度好转。但因患者伴随疾病多,终究没有解除其肠缺血、坏死的根本原因,最终发生多脏器功能衰竭而死亡。本文同时就NOMI的发病机制、临床表现、诊断及治疗进行文献复习。

Acute non -occlusive mesenteric ischemia （NOMI） is a rare disorder with a high mortality rate. The early clinical findings are vague and nonspecific. Ultrasound and CT scan are helpful for the diagnosis, and mesenteric angiography is the gold standard. Vasodilators are the first choice of treatment, and operation is necessary for those suspected of acute abdo- men. This paper reports a patient of NOMI, whose complaint was abdominal pain during the course of gastrointestinal bleed- ing. NOMI was diagnosed with the help of CT angiography. With the treatments of gastrointestinal decompression, antibiotics, ox- ygen inhalation and papaverine infusion, the symptoms were once improved. Fatal multiple organ failure finally occurred due to in- testine ischemia and severe comorbidities. This article also reviewed the literatures of pathogenesis, clinical manifestation, diag- nosis and management of NOMI.