肠系膜上动脉栓塞的临床特征分析

Clinical characteristics in patients with superior mesenteric artery embolism

[目的]探讨肠系膜上动脉栓塞(superior mesenteric artery embolism,SMAE)的临床特征。[方法]纳入诊断为SAME患者42例,根据治疗结果分为好转组与死亡组,对其临床资料进行统计学分析。[结果]42例患者平均年龄为(65.8±13.7)岁,男27例(64.3%)女15例(35.7%),伴有高血压22例、动脉硬化16例、心房颤动17例、动脉栓塞史14例、糖尿病9例、腹部手术史8例。所有患者均为急性腹痛起病,伴有恶心呕吐27例、便血17例。中性粒细胞百分比升高32例、白细胞升高27例、C-反应蛋白升高29例、凝血酶原时间延长32例、活化部分凝血酶原时间延长17例、纤维蛋白原升高22例、D-二聚体升高23例。血管CT确诊的36例患者均发现肠系膜上动脉管腔充盈缺损,腹腔积液21例、肠管增厚积气14例、肠坏死11例,肠梗阻3例。死亡组平均年龄为(74.5±9.8)岁,显著高于好转组的(62.8±13.7)岁,2组比较P<0.05。死亡组患有心脏疾病、多处动脉栓塞人数明显多于好转组(P<0.05)。死亡组患高血压、糖尿病、心房颤动例数多于好转组,伴有恶心、呕吐、消化道出血、肠坏死、腹膜刺激征人数多于好转组,但均差异无统计学意义。保守治疗、外科开腹治疗及血管内介入治疗死亡率分别为28.0%(7/25)、16.7%(2/12)及20.0%(1/5例)。[结论]SMAE临床表现及实验室资料无特异性,腹部症状较重而体征较轻为其特点之一,腹部CTA检查是诊断本病的最佳方法,血管内溶栓或取栓,以及开腹手术治疗是最有效的治疗措施,血小板显著减少及存在多处血管栓塞者预后差。

[Objective]To explore the clinical characteristics of superior mesenteric artery embolism(SMAE),so as to improve the understand of this disease,achieve early diagnosis and treatment and increase the cure rate.[Methods]A total of 42patients who were diagnosed with SMAE in a tertiary hospital from September 2015to November 2020were collected as the study group.According to the treatment outcome of the cases,they were divided into death group(n=10)and improvement group(n=32).The hospitalization data of 42patients were collected for statistical analysis.[Results]The average age of the 42patients was(65.8±13.7)years old,more men(27/42,64.3%)than women(15/42,35.7%).Total 22cases(52.4%),patients had history of hypertension,16cases(41.0%)had arteriosclerosis,17cases(40.5%)had atrial fibrillation,14cases(33.3%)had embolison,9cases(21.4%)had diabetes and 8cases(19.0%)had abdominal operation history.All patients had onset of acute abdominal pain.The patients were accompanied by vomiting in 27cases(64.3%)and hematochezia in 17cases(40.5%).The neutrophil percentage was elevated in 32cases(76.2%),white blood cells was elevated in 27cases(64.3%),c-reaction protein was elevated in 29cases(69.0%),prothrombin time was prolonged in 32cases(76.2%),activated partial thromboplastin time was prolonged in 17cases(40.5%),fibrinogen was elevated in 22cases(52.4%),ddimerwas elevated in 23cases(54.8%).All of 36patients diagnosed by computed tomography angiography(CTA)were found the superior mesenteric artery filling-defect(100%),and observed seroperitoneum in 21/41cases(51.2%),intestinal wall pneumatosis and incrassation in 14/41cases(34.1%),intestinal necrosis in 11cases(26.2%),and intestinal obstruction in 3cases(7.1%).The average age of the death group(74.5±9.8years old)was older than improvement group(62.8±13.7years old),P<0.05.More the cases of death group who were sufferd from heart disease and multiple vascular embolism than improvement group(P<0.05).There were more hypertension,diabetes,atrial fibrillation patients in death group than in improvement group,and more accompanied by nausea,vomiting,hemorrhage of digestive tract,intestinal necrosis,sign of peritoneal irritation than improvement group,but the difference were not statistically significant.Conservative treatment resulted in the most deaths 7/25cases(28.0%),2/12cases(16.7%)died after exploratory laparotomy and 1/5cases(20%)died after intravascular thrombolysis or thrombectomy.[Conclusion]SMAE have no characteristic clinical manifestation and laboratory inspection.Severe abdominal symptoms with slight signs is one of the characteristics.Abdominal CTA is the best method to diagnose this disease.Intravascular thrombolysis or thrombectomy and exploratory laparotomy are the most effective treatments.Patients who have reduce more platelets and/or with multiple vascular embolism would have a poorer prognosis.Clinicians must increase their awareness of SMAE.