肠系膜动脉栓塞中非瓣膜病心房颤动患者的临床分析

Clinical analysis on acute mesenteric artery embolism in patients with non valvular atrial fibrillation

目的对非瓣膜病心房颤动患者发生急性肠系膜动脉栓塞(AMAE)的临床特点进行分析。方法回顾分析我院近10年住院的非瓣膜病心房颤动患者并发AMAE的临床资料。2005年1月至2015年1月在中山大学孙逸仙纪念医院收治的36例患者,男女比率为1.57∶1。几乎所有患者以腹痛为首发症状来诊,且多为持续性剧烈疼痛。结果在12 685例非瓣膜病心房颤动患者中,AMAE发生率低,近10年仅11例(0.09%),但占所有36例AMAE患者的30.6%。所有AMAE患者3个月内均未服用过抗凝药物。腹痛是AMAE患者首发症状,但早期体征不明显,D-二聚体正常。AMAE患者总死亡率为27.3%,手术患者死亡率为12.5%,保守治疗患者死亡率为66.7%。结论 AMAE是非瓣膜病心房颤动的少见并发症,但房颤是AMAE的重要危险因素;CTA对本病的诊断有重要意义,D-二聚体对早期诊断意义不大;服用抗凝药物预防发病及确诊后尽早手术是降低死亡率的重要手段。

Objective To investigate clinical manifestation of acute mesenteric artery embolism( AMAE) in patients with non valvular atrial fibrillation. Methods The retrospective study was performed on the clinical data of non valvular atrial fibrillation patients combined with acute mesenteric artery embolism admitted into the Second Affiliated Hospital of Sun Yat-sen University from January 2005 to January 2015.There were 36 patients,with ratio of male to female of 1. 57 ∶ 1. Nearly all patients were admitted due to stomach,most the persistent and acute pain. Results The incidence of AMAE was about 0. 09% among 12685 non valvular atrial fibrillation patients,but the incidence of AMAE was about 30. 6% in these 36 patients. All AMAE patients did not take anticoagulant drugs within 3 months. Belly pain was the starting symptom of AMAE,with normal D-dimer level. The total mortality of AMAE was 27. 3%,with mortality of12. 5% for surgery patients and 66. 7% for non-surgery patients. Conclusions AMAE is a rare involvement of non valvular atrial fibrillation,when atrial fibrillation is the risk factor for AMAE. CTA serves as a valuable supplementary approach in the diagnosis. Taking anticoagulant drugs and operation is effective in decrease of mortality.