老年人急性肠系膜缺血的临床特征

Clinical features of acute mesenteric ischemia in the elderly

目的探讨老年人急性肠系膜缺血（AMI）的临床特征，为老年人AMI的早期预防、诊治提供依据。方法将104例住院AMI患者分为老年组（≥60岁）和中青年组（〈60岁），对其临床表现、误诊情况、血液生化检查、基础疾病、治疗及预后等进行回顾性对比分析。结果老年AMI患者以急性肠系膜上动脉血栓栓塞（ASMATE）为主要病因，中青年患者以急性肠系膜静脉血栓形成（ASMVT）为主要病因；老年患者误诊率高于中青年患者（P=0．007）。AMI患者最常见的临床表现是腹痛（100．0％），其次是呕吐（58．7％）；老年患者更易出现恶心、呕吐（P〈0．05）。老年组血肌酐、血尿素及尿酸水平高于中青年组（P〈O．05），而D-二聚体水平低于中青年组（P=0．036）。老年组并存高血压、心房颤动、动脉粥样硬化、缺血性心脏病、脑梗死及慢性肾功能不全更为多见（P〈O．05），中青年组饮酒史多于老年组（P=0．042）。高血压、动脉粥样硬化、脑梗死是老年AMI患者发病独立的相关因素（P=0．000，OR=4．057；P=0．001，OR=4．585；P=0．007，OR=4．269）；老年组结肠坏死者多（P=0．038），预后差（P=0．001）。结论老年AMI患者以急性肠系膜上动脉血栓栓塞为主要病因。临床表现以恶心、呕吐为主，肾功能受损指标明显升高。高血压、动脉粥样硬化及脑梗死是老年人AMI发病独立的相关因素。老年AMI患者更容易出现误诊，且病情更重，预后更差。

Objective To investigate the clinical features of acute mesenteric ischemia （AMI） in the elderly and provide evidence for early prevention, diagnosis and treatment of AMI for elderly patients. Methods A retrospective analysis was performed in 104 patients with AMI in our hospital, who were divided into two groups： the elderly group （aged^60 years） and the non-elderly group （aged 60 years）. Clinical manifestations, misdiagnosis rate, laboratory data, underlying diseases, treatment and prognosis were compared between the two groups. Results Acute superior mesenteric artery thromboembolus （ASMATE） was the main cause of AMI in the elderly group and acute mesenteric venous thrombosis （ASMVT） was the main cause of AMI in the non-elderly group. Elderly patients were more prone to misdiagnosis as compared with the non-elderly group （P = 0. 007）. Abdominal pain （100.0%） was the most common clinical manifestation of AMI patients, followed by vomiting （58.7% ）. Nausea and vomiting were strongly associated with AMI in the elderly （P〈0.05）. In laboratory data, serum creatinine, lactate dehydrogenase and uric acid were higher and the D-Dimer level was lower in elderly patients than in non-elderly patients （P〈0.05）. Hypertension, atrial fibrillation, arteriosclerosis, ischemic heart disease, cerebral infarction and chronic renal insufficiency were more common in the elderly with AMI （all P〈0.05）, while history of alcohol intake was higher in the non-elderly group （P= 0. 042）. Hypertension, arteriosclerosis and cerebral infarction were independent relevant factors for elderly-onset AMI （P= 0. 000, OR=4. 057; P= 0. 001, OR=4. 585% P=0. 007, OR=4. 269）. The number of patients with colon necrosis was higher in the elderly group than in the non-elderly group （P=0. 038）, and the prognosis was worse in the elderly group than in the non-elderly group （P=0. 001）. Conclusions ASMATE is the main cause of AMI in elderly patients. Nausea and vomiting are the main clinical manifestations, together with impaired renal function. Hypertension, arteriosclerosis and cerebral infarction are the independent relevant factors for elderly-onset AMI. Elderly patients are more prone to misdiagnosis, show more severity and have worse prognosis.