经手术及血管影像学检查证实的66例急性肠系膜上动脉栓塞的临床分析

Clinical analysis of 66 cases of acute superior mesenteric artery embolism confirmed by surgery and angiography

目的探讨急性肠系膜上动脉栓塞(ASMAE)患者的临床表现、治疗和预后。方法收集2012年10月至2018年3月于重庆医科大学附属第一医院就诊的66例ASMAE患者的病历资料,进行回顾性研究。依据ASMAE患者住院期间是否死亡,将纳入患者分成死亡组和生存组,比较两组的临床特征、确诊时间和治疗方式等。统计学方法采用t检验或卡方检验。结果66例ASMAE患者中,死亡组16例,生存组50例。死亡组年龄为(75.6±9.9)岁,大于生存组的(68.1±13.2)岁,差异有统计学意义(t=1.998,P=0.041)。16例死亡患者中,确诊时间≤6h、伴心房颤动、腹膜刺激征、肠鸣音减弱或消失、伴全身炎症反应综合征者分别为0、14、9、9、16例;50例存活患者中,确诊时间≤6h、伴心房颤动、腹膜刺激征、肠鸣音减弱或消失、伴全身炎症反应综合征者分别为15例(30.0%)、30例(60.0%)、14例(28.0%)、14例(28.0%)、36例(72.0%);两组差异均有统计学意义(χ^2=4.621、4.125、4.261、4.261、4.134,P均<0.05)。结论合并心房颤动的老年患者突发剧烈腹痛时,需警惕ASMAE。早期(≤6h)正确诊断有助于改善ASMAE患者的预后。

Objective To explore the clinical manifestation, treatment and prognosis of patients with acute superior mesenteric artery embolism (ASMAE). Methods From October 2012 to March 2018, the clinical data of 66 patients with ASMAE who were admitted to The First Affiliated Hospital of Chongqing Medical University were collected and retrospectively analyzed. The patients were divided into the death group and the survival group according to whether they died during hospitalization. The clinical features, the time of diagnosis and treatment methods of two groups were compared. T-test and chi-square test were performed for statistical analysis. Results Among 66 ASMAE patients, 16 were in the death group and 50 in the survival group. The age of the death group was (75.6±9.9) years, which was greater than that of the survival group ((68.1±13.2) years), and the difference was statistically significant (t=1.998, P=0.041). Among 16 dead patients, the case numbers of diagnosis time less than six hours, complicated with atrial fibrillation, peritoneal irritation sign, weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 0, 14, 9, 9 and 16, respectively. However, among 50 survival patients, the case numbers of diagnosis time less than six hours, complicated with atrial fibrillation, peritoneal irritation sign, weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 15 (30.0%), 30 (60.0%), 14 (28.0%), 14 (28.0%) and 36 (72.0%), respectively. The differences between two groups were all statistically significant (χ^2=4.621, 4.125, 4.261, 4.261 and 4.134, all P<0.05). Conclusions When sudden severe abdominal pain occurs in elderly patients with atrial fibrillation, ASMAE should be alerted. Early (less than six hours) and correct diagnosis can improve the prognosis of the ASMAE patients.