急性肠系膜动脉缺血的药物治疗

Medical therapy in acute mesenteric arterial ischemia

急性肠系膜动脉缺血是一种发生率较低的血管科急腹症。这一类疾病包括肠系膜上动脉血栓形成、栓塞及痉挛等不同病理生理机制导致的突发性肠系膜动脉血流受阻。急性肠系膜动脉缺血病死率较高,原因是在急腹症的鉴别诊断中对其认识不足,导致确诊和治疗的延误。急性肠系膜动脉缺血的病人必须及时诊断并即刻开始治疗,治疗手段包括药物复苏及治疗、血管腔内治疗和外科血管重建及坏死肠管切除。积极有效的药物治疗是改善预后的关键,也是整个治疗过程的基础,必须加以重视。

Acute mesenteric arterial ischemia is a vascular emergency with a low incidence. Several pathophysiologic events （arterial embolism, arterial thrombosis and diffuse vasospasm） lead to a sudden decrease in mesenteric blood flow. The mortality rate of mesenteric arterial ischemia remains high. The reason is insufficient understanding of its clinical picture in differential diagnosis of abdominal pain, thus there always is an unacceptable time delay before treatment. Every patient with acute mesenteric arterial ischemia must be diagnosed urgently and begin to receive therapy immediately. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular therapy, surgical resection and revascularization. Prompt and appropriate medical treatment is the key to a better outcome and is the foundation of whole therapeutic process.