心脏外科术后非闭塞性肠系膜缺血的发生机制及诊疗进展

The mechanisms and the diagnosis progress of non-obstructive mesenteric ischemia after cardiac surgery

非闭塞性肠系膜缺血(non-obstructive mesenteric ischemia,NOMI)是由于血管痉挛导致局部血流灌注受损而引起一系列消化道功能紊乱的疾病,同时也是重症监护室内常见的肠道并发症,尤其见于心脏手术后血流动力学不稳定的患者,且病死率较高,是一种极其凶险的疾病。心脏外科手术旨在改善患者预后,然而NOMI的并发很容易被忽视,从而阻碍术后患者的恢复。NOMI的发生发展速度快,缺乏特异性的症状和体征,易被误诊为其他胃肠道并发症。因此,及时有效的诊断NOMI是影响心脏外科术后预后最重要的因素。本文系统回顾了目前心脏外科术后导致NOMI的相关研究,对NOMI的发生原因、机制、治疗及预后等方面做了全面的综述,并着重介绍NOMI诊断手段的最新进展,以期为临床医生在临床工作中对NOMI的准确鉴别及及时干预提供方向。

Non-occlusive mesenteric ischemia(NOMI)is a series of disorders of digestive tract caused by local blood perfusion damage,which is caused by vasospasm.As an extremely dangerous disease,NOMI is also a common intestinal complication in intensive care unit,especially in patients with hemodynamic instability after cardiac surgery,and the mortality is high.Cardiac surgery aims to improve the prognosis of patients,while the complication of NOMI is easy to be ignored,which hindered the recovery of postoperative patients.Due to the rapid development and lack of specific symptoms and signs,NOMI is easily misdiagnosed as other gastrointestinal complications.Therefore,timely and effective diagnosis of NOMI is the most important factor affecting the prognosis of post cardiac surgery.This review systematically summarized the related research on NOMI after cardiac surgery,and comprehensively concluded the cause,mechanism,treatment as well as prognosis of NOMI.Then we emphasized on the latest progresses of diagnostic methods for NOMI,in order to provide directions on the accurate identification and timely intervention of NOMI in clinical work.