Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture:A case report

BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.

Mesenteric lymph reperfusion may exacerbate brain injury in a rat model of superior mesenteric artery occlusion shock

BACKGROUND：The intestinal lymphatic pathway and intestinal ischemia/reperfusion are mainly involved in mesenteric lymph duct ligation or drainage; moreover,intervention by reducing the lymph liquid reflux might relieve lung and other organ dysfunction induced by intestinal ischemia/reperfusion; however,research addressing mesenteric lymph reperfusion （MLR） and brain injury has not yet to be reported.OBJECTIVE：To observe the effect of MLR on brain tissue in a rat model of superior mesenteric artery occlusion （SMAO） shock,and to explore the molecular mechanism of MLR.DESIGN,TIME AND SETTING：A randomized,controlled,animal experiment at a neuro-pathophysiology level was performed at the Institute of Microcirculation,Hebei North University; Department of Pathophysiology,Basic Medical College; Department of Pathology,the First Hospital of Hebei North University between December 2007 and March 2009.MATERIALS：Adenosine triphosphate （ATP） standard was provided by the National Institute for the Control of Pharmaceutical and Biological Products; lactic acid （LA）,superoxide dismutase （SOD）,malonaldehyde （MDA）,nitrogen monoxidum （NO）,nitric oxide synthase （NOS）,myeloperoxidase （MPO） and ATPase assay kits were provided by Nanjing Jiancheng Bioengineering Institute,China.METHODS：A total of 24 male Wistar rats were randomly divided into four groups.In the sham-surgery group （n = 6）,both the mesenteric lymph duct and the superior mesenteric artery were not blocked; in the MLR group （n = 6）,the mesenteric lymph duct was occluded for 1 hour followed by 2-hour reperfusion; in the SMAO group （n = 6）,the superior mesenteric artery was occluded for 1 hour followed by 2-hour reperfusion; in the MLR ＋ SMAO group （n = 6）,both the mesenteric lymph duct and superior mesenteric artery were occluded for 1 hour followed by 2-hour reperfusion.MAIN OUTCOME MEASURES：Mean arterial blood pressure prior to and following ischemia/reperfusion; brain tissue morphology levels of LA,MDA,SOD,NO,NOS,MPO,ATPase and ATP following reperfusion.RESULTS：MLR did not cause changes in mean arterial blood pressure,brain tissue morphology,LA,MDA,NO,ATP,SOD,NOS,MPO and ATPase.However,SMAO caused a rapid decrease and gradual increase of mean arterial blood pressure.Neuronal necrosis,degeneration and swelling were observed in brain tissue.Contents of MDA,NO,LA and ATP as well as activities of NOS and MPO were significantly increased （P〈 0.05）,but activities of SOD and Na＋-K＋-ATPase were significantly decreased （P 〈 0.05）.MLR aggravated neuronal damage in a rat model of SMAO shock.Following MLR,mean arterial blood pressure was significantly decreased （P 〈 0.05）,contents of MDA and NO as well as activities of NOS and MPO were significantly increased （P 〈0.05）,but activities of Ca2＋-ATPase,Mg2＋-ATPase and Ca2＋-Mg2＋-ATPase as well as ATP content were significantly decreased （P〈 0.05）.CONCLUSION：MLR aggravates brain injury in a rat model of SMAO shock,which correlates with oxygen-derived free radical injury,NO synthesis and release,sequestration of neutrophilic granulocytes,decreasing activity of cell membrane pumps and energy metabolism dysfunction.Pathogenesis of the intestinal lymphatic pathway should be thoroughly investigated to prevent ischemia/reperfusion injury.

Influence of mesenteric lymph reperfusion on neurotransmitter expression in brain tissue of a superior mesenteric artery occlusion shock rat model

BACKGROUND： Previous studies have shown that mesenteric lymph reperfusion （MLR） exacerbates brain injury in a rat model of superior mesenteric artery occlusion （SMAO） shock. However, little is known about the influence of MLR on neurotransmitter expression in brain tissue. OBJECTIVE： To observe the effect of MLR on brain tissue injury by measuring monoamine and cholinergic neurotransmitter levels. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Institute of Microcirculation, Hebei North University, China; Research Room of Microcirculation and Laboratory of Biochemistry, Department of Pathophysiology, Basic Medical College, Hebei North University between December 2007 and March 2009. MATERIALS： Choline acetyltransferase （CHAT） and acetylcholine esterase （ACHE） kits were provided by Nanjing Jiancheng Bioengineering Institute, China; dopamine （DA） and noradrenalin （NE） standards were provided by the National Institute for the Control of Pharmaceutical and Biological Products; HP1100 chromatograph of liquid was provided by Agllent, USA. METHODS： A total of 24 male, Wistar rats were randomly assigned to 4 groups： sham-surgery, MLR SMAO, and MLR ＋ SMAO groups, with 6 rats in each group. In the MLR or SMAO groups, the mesenteric lymph duct or superior mesenteric artery was blocked for 1 hour. In the MLR ＋ SMAO group, the mesenteric lymph duct and superior mesenteric artery were occluded for 1 hour, followed by 2-hour repeffusion. ChAT and AChE levels were measured using the synthesized and hydrolyzed acetylcholine method, respectively. Liquid chromatography was employed to quantitatively analyze DA and NE levels, using relative retention time and the external standard method. MAIN OUTCOME MEASURES： CHAT, ACHE, DA, and NE levels. RESULTS： AChE levels were significantly increased, but ChAT levels were significantly decreased in the MLR and MLR ＋ SMAO groups following 2-hour repeffusion （P〈 0.01）. However, AChE activity in the MLR ＋ SMAO group was greater than in the MLR group （P 〈 0.05）. DA and NE levels were significantly decreased in the SMAO and MLR ＋ SMAO groups （P〈 0.01）, while DA levels in the MLR ＋ SMAO group were less than in the SMAO group （P 〈 0.05）. CONCLUSION： MLR exacerbated brain injury in a rat model of SMAO shock, which correlated with the intestinal lymphatic pathway. MLR decreased DA levels, but increased AChE activity, in a rat model of SMAO shock.

Aspiration therapy for acute embolic occlusion of the superior mesenteric artery

BACKGROUND Embolic superior mesenteric artery(SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However,most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.METHODS This retrospective study reviewed eight patients(six males and two females)from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography(CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.RESULTS Six(75%) patients were male, and the mean patient age was 70.00 ± 8.43 years(range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications(the clot broke off during aspiration).CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death,resolving thrombi, and improving symptoms.

Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.

Abdominal Aortic Aneurysm Repair in a Patient with Superior Mesenteric Artery Occlusion with Transient Intraoperative Infusion of the Inferior Mesenteric Artery: A Surgical Case Report

Abdominal aortic aneurysms (AAA) with mesenteric artery stenosis or obstructive lesions are occasionally recognized. While performing the graft replacement operation in such cases, if the collateral circulation supplying the gastrointestinal tract is well developed, it is necessary that this collateral circulation should be well perfused during aortic cross-clamping. A 72-year-old woman was admitted because of expansion of AAA. Computed tomography (CT) scan examination revealed occlusion at the origin of the superior mesenteric artery (SMA) and the development of a collateral circulatory pathway via the inferior mesenteric artery (IMA). During this operation, a vein cannula was placed in the IMA, through which blood was supplied with an extension tube for the protection of the intra-abdominal organs. The IMA was reimplanted after the graft replacement. Previous reports indicate that intestinal ischemia may be successfully prevented by supplying blood to the collateral circulation using various techniques. We report the surgical approach for treatment of AAA using a simple and convenient method to maintain intra-operative blood supply to vital organs.

Endoscopy-based early enterostomy closure for superior mesenteric arterial occlusion

AIM:To evaluate the efficacy of endoscopic examination of blood flow and edema in the remnant bowel.METHODS:We retrospectively studied 15 patients who underwent massive bowel resection with enterostomy for superior mesenteric arterial occlusion (SMAO); the patients were divided into a delayed closure group (D group) and an early closure group (E group).RESULTS:The mean duration from initial operation to enterostomy closure was significantly shorter in the E group (18.3 ± 2.1 d) than in the D group (34.3 ± 5.9 d) (P < 0.0001). The duration of hospitalization after surgery was significantly shorter in the E group (33 ± 2.2 d) than in the D group (51 ± 8.9 d) (P < 0.0002).CONCLUSION:Endoscopic examination of blood flow and edema in the remnant bowel is useful to assess the feasibility of early closure of enterostomy in SMAO cases.

Acute celiac artery occlusion secondary to blunt trauma:Two case reports

BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is usually atypical,which easily causes missed diagnosis and misdiagnosis.Currently,there are only a few reports of acute traumatic occlusion of CA.The CA artery gives off branches to dominate the liver,stomach.and spleen;however,occluded CA did not cause significant organ ischemia,and the compensatory blood flow from the superior mesenteric artery(SMA)played a pivotal role.CASE SUMMARY Herein,we report two cases of acute CA occlusion secondary to severe blunt trauma.Case one was a 19-year-old male,suffered from a motorcycle crash.He complained of dyspnea,and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound.Computed tomography(CT)scan revealed hemopneumothorax,multiple rib fractures,right scapular fracture,and liver rupture.Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased,and CA was occluded.Because the hepatic hemorrhage is associated with hepatic artery injury,the CA was retrogradely opened through the SMA,and then,the right hepatic artery was embolized with coils successfully through the conventional pathway.Stent implantation was not performed,and the CA occlusion was managed by conservative treatment.A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded.Case two was a 37-year-old man,suffered injury from fall from height.He complained of lower back and bilateral heel pain.Contrast-enhanced CT examination revealed multiple rib fractures,bilateral pneumothorax,fourth lumbar(L4)vertebral burst fracture,and pelvic fractures.Furthermore,a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected.The reexamination 14 h after admission showed the CA was occluded.The patient was conservatively treated.The symptoms of nausea after meals disappeared about 4 wk later,and abdominal distension was significantly relieved after 6 wk.The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.CONCLUSION Patients with CA occlusion will have different clinical manifestations,and the dominant organ will not have obvious ischemia.Conservative treatment is safe,and the patient’s symptoms will be improved with the establishment of collateral circulation.

Acute arterial mesenteric ischemia and reperfusion:Macroscopic and MRI findings, preliminary report

AIM:To explore the physiopathology and magnetic resonance imaging(MRI)findings in an animal model of acute arterial mesenteric ischemia(AAMI)with and without reperfusion.METHODS:In this study,8 adult Sprague-Dawley rats underwent superior mesenteric artery(SMA)ligation and were then randomly divided in two groups of 4.In groupⅠ,the ischemia was maintained for 8 h.In groupⅡ,1-h after SMA occlusion,the ligation was removed by cutting the thread fixed on the back of the animal,and reperfusion was monitored for 8 h.MRI was performed using a 7-T system.RESULTS:We found that,in the case of AAMI without reperfusion,spastic reflex ileus,hypotonic reflex ileus,free abdominal fluid and bowel wall thinning are present from the second hour,and bowel wall hyperintensity in T2-W sequences are present from the fourth hour.The reperfusion model shows the presence of early bowel wall hyperintensity in T2-W sequences after 1 h and bowel wall thickening from the second hour.CONCLUSION:Our study has shown that MRI can assess pathological changes that occur in the small bowel and distinguish between the presence and absence of reperfusion after induced acute arterial ischemia.

A framework for the modeling of gut blood flow regulation and postprandial hyperaemia

After a meal the activity of the gut increases markedly as digestion takes place. Associated with this increase in activity is an increase in blood flow, which has been shown to be dependent on factors such as caloric content and constitution of the meal. Much qualitative work has been carried out regarding mechanisms for the presence of food in a section of gut producing increased blood flow to that section, but there are still many aspects of this process that are not fully understood. In this paper we briefly review current knowledge on several relevant areas relating to gut blood flow, focusing on quantitative data where available and highlighting areas where further research is needed. We then present new data on the effect of feeding on flow in the superior mesenteric artery. Finally, we describe a framework for combining this data to produce a single model describing the mechanisms involved in postprandial hyperaemia. For a section of the model, where appropriate data are available, preliminary results are presented.

中西医结合治疗肠系膜上动脉闭塞致严重并发症1例

本文报道了1例肠系膜上动脉(SMA)闭塞致严重并发症患者:女性,57岁,入院前无明显诱因出现上腹部疼痛,呈间歇性隐痛,持续时间1~2 h,伴呃逆。入院完善相关检查,诊断为:(1)SMA栓塞;(2)小肠坏死并弥漫性腹膜炎;(3)腹主动脉多发溃疡并血肿、主动脉硬化。患者签署手术同意书后在全麻下行经SMA切开Fogarty球囊扩张动脉成形+肠系膜动脉取栓术+肠切除吻合术,术中取出SMA中2 cm栓塞物,根据患者肠管坏死情况切除约200 cm小肠。术后转入ICU监护治疗,后转入普通病房,术后患者表现为典型的“断肠综合征”症状,门诊长期口服中药(辨证用药)治疗,病情基本得到控制。

肠淋巴再灌注对肠系膜上动脉闭塞性休克多器官损伤的影响

目的:观察肠淋巴再灌注(MLR)对肠系膜上动脉闭塞性(SMAO)休克大鼠血压、存活率以及器官功能的影响。方法:Wistar雄性大鼠均分为4组:sham组,仅麻醉与手术;MLR组,夹闭肠系膜淋巴管(ML)1h,再灌注2h;SMAO组,夹闭肠系膜上动脉(SMA)1h,再灌注2h;MLR+SMAO:夹闭ML和SMA1h,再灌注2h。观察3h期间平均动脉血压(MAP)变化后,观察肺、肝、肾、心肌功能和形态学变化。记录24h存活率。结果:①sham、MLR、SMAO组大鼠24h存活率(分别为100%、83.3%、66.7%)显著高于MLR+SMAO组(0%)。②夹闭SMA或ML前10min,组间MAP无差异;SMAO组MAP在夹闭后多个时点显著高于MLR+SMAO和sham组;再灌注后,MLR和sham组MAP无明显变化,SMAO和MLR+SMAO组MAP迅速下降,后逐渐回升,SMAO组多个时点低于MLR和sham组,MLR+SMAO组在所有时点均低于MLR、sham和SMAO组。③MLR+SMAO组天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、肌酐(Cre)、乳酸脱氢酶-1(LDH-1)、肌酸激酶同工酶(CK-MB)均显著高于sham组、MLR组、SMAO组,且SMAO组的这些指标显著高于sham组、MLR组。形态学观察显示sham组与MLR组的肺、肝、心、肾结构基本正常,SMAO组各脏器有一定的组织学损伤,而MLR+SMAO组则可见炎症、出血、核浓缩、破碎等严重病变。结论:MLR可加剧SMAO休克多个器官损伤,肠淋巴途径在SMAO休克的发病学中具有重要作用。

肠淋巴再灌注加剧SMAO休克多器官损伤的作用机制

目的:探讨肠淋巴再灌注(MLR)加剧肠系膜上动脉闭塞性(SMAO)休克大鼠多器官损伤的作用机制。方法:Wistar雄性大鼠均分为4组:sham组,仅麻醉与手术;MLR组,夹闭肠系膜淋巴管(ML)1 h,再灌注2 h;SMAO组,夹闭肠系膜上动脉(SMA)1 h,再灌注2 h;MLR+SMAO:夹闭ML和SMA1 h,再灌注2 h。制备肝、肾、心、肺组织匀浆,检测自由基、一氧化氮(NO)、髓过氧化物酶(MPO)、细胞膜泵活性。结果:SMAO组及MLR+SMAO组多个器官组织匀浆的MDA、NO含量及NOS、MPO活性均显著高于sham组及MLR组,且MLR+SMAO组肝、肾、心、肺组织匀浆的这些指标高于SMAO组;SMAO组及MLR+SMAO组有多个器官组织匀浆SOD和ATPase活性显著低于sham组及MLR组,MLR+SMAO组均低于SMAO组。结论:MLR加剧SMAO休克多器官损伤的作用机制与加剧自由基损伤、NO合成与释放、中性粒细胞扣押、降低细胞膜泵活性有关,肠淋巴途径在SMAO休克的发病学中具有重要作用。

介入取栓术治疗急性肠系膜上动脉栓塞临床研究

目的评价经皮肠系膜上动脉吸栓和(或)溶栓治疗急性肠系膜上动脉栓塞的疗效。方法34例急性肠系膜上动脉栓塞的患者(房颤14例;左房黏液瘤2例;血栓形成15例;慢性缺血性肠病急性发作3例),行经皮动脉长鞘吸栓术和(或)溶栓术。结果34例患者均成功的去除栓子,动脉开通。31例痊愈;2例行开腹探查;1例24h后死亡。结论经皮介入取栓术对于治疗急性肠系膜上动脉栓塞,是一种简便有效的方法。准确地判断病因是提高疗效,避免合并症的关键。

急性肠系膜上动脉栓塞的介入治疗

目的 评价经皮肠系膜上动脉吸栓治疗急性肠系膜上动脉栓塞的疗效。 方法 7例急性肠系膜上动脉栓塞的患者 (心房纤颤 4例 ;左房粘液瘤 2例 ;慢性缺血性肠病 1例 ) ,行经皮动脉长鞘 (Optimed公司 )吸栓术。 结果 7例均成功取出栓子 ,动脉开通。 5例痊愈 ;1例行开腹探查 ;1例 2 4小时后死亡。 结论 经皮长鞘吸栓术对于治疗急性肠系膜上动脉栓塞 。

彩色多普勒血流显像对肠系膜上动脉闭塞性疾病的诊断价值

目的探讨彩色多普勒血流显像诊断肠系膜上动脉闭塞性疾病的临床价值。资料与方法回顾20例经血管造影证实的肠系膜上动脉闭塞性病变的彩色多普勒血流表现,分析血流频谱与管腔狭窄程度的关系。结果本组中完全性闭塞3例,均经超声检出;15例重度狭窄中,超声误诊为闭塞1例,其余14例与血管造影结果相符;2例中度狭窄的病变,超声误判为重度。结论彩色多普勒血流显像能准确诊断肠系膜上动脉闭塞性疾病。

内毒素移位在肠淋巴再灌注加剧SMAO休克大鼠多器官损伤中的作用

目的:探讨肠源性内毒素移位在肠淋巴再灌注(MLR)加剧肠系膜上动脉闭塞性(SMAO)休克多器官损伤中的作用与机制。方法:24只Wistar大鼠随机分为4组(n=6):假手术组(Sham,仅麻醉与手术)、MLR组(夹闭肠系膜淋巴管1 h,再灌注2 h)、SMAO组(夹闭肠系膜上动脉1 h,再灌注2 h)和SMAO+MLR组(同时夹闭肠系膜淋巴管和肠系膜上动脉1 h,再灌注2 h)。再灌注2 h后,腹主动脉取血,制备血浆;留取固定位置的肝、肾、心肌、肺组织,制备组织匀浆。应用鲎试剂动态浊度法检测血浆以及各组织匀浆内毒素(ET)含量;应用酶联免疫方法检测各器官组织匀浆脂多糖结合蛋白(LBP)、脂多糖受体(CD14)和肿瘤坏死因子(TNF-α)水平。结果:Sham组和MLR组各指标均无统计学差异;SMAO组及SMAO+MLR组的血浆、肝、肾、心肌、肺组织匀浆的ET含量均显著高于Sham组和MLR组,且SMAO+MLR组血浆及各组织匀浆的ET水平均显著高于SMAO组;SMAO组及SMAO+MLR组肝、肾、心肌、肺组织匀浆CD14、LBP和TNF-α水平显著高于Sham组及MLR组,且SMAO+MLR组各指标均高于SMAO组。结论:MLR加剧SMAO休克多器官损伤的作用机制与ET经过肠淋巴途径移位、激活内毒素增敏系统LBP/CD14、促进炎症反应有关。

急性肠系膜上动脉栓塞动物模型的建立

目的制作一种适合后续去栓治疗的急性肠系膜上动脉栓塞动物模型。方法8只杂种犬,体外制作动物自体血栓,采用经皮股动脉穿刺入路,选择性插入8F动脉长鞘至犬肠系膜上动脉主干后注入自体血凝块,造影复查直至肠系膜上动脉主干完全闭塞。分别在栓塞后2、4、6和8h于肠系膜上动脉开口部造影复查,观察自体血栓是否稳定,肠系膜上动脉有无自行再通,并经腹部切口探察,取病理活检。结果8只实验犬均成功建立急性肠系膜上动脉栓塞致肠缺血模型。大体观察及镜下可见随栓塞时间的延长,肠管损伤逐渐加重,组内一致性良好。结论采用本实验方法可成功建立适合后续去栓治疗研究的急性肠系膜上动脉栓塞动物模型。

急性肠系膜上动脉缺血35例治疗体会

目的探讨急性肠系膜上动脉缺血的诊断和外科治疗。方法回顾性分析2006年1月—2012年10月收治的35例急性肠系膜上动脉缺血的临床资料。结果除2例入院后经保守治疗症状缓解外,33例均行急诊手术或介入治疗。35例住院时间为(14.00±4.86)d,均顺利出院,随访2～28个月,未见复发。结论急性肠系膜上动脉缺血早期诊断是关键,一旦确诊,应采取积极外科干预治疗。

急性非闭塞性肠系膜血管缺血的诊断和介入治疗

目的探讨选择性肠系膜上动脉造影,经肠系膜上动脉持续灌注罂粟碱在诊断和治疗急性非闭塞性肠系膜血管缺血(NOMI)的价值。方法回顾分析从1999年8月到2005年3月经选择性肠系膜上动脉造影确诊,并行介入诊疗的18例NOMI。明确NOMI诊断后即行经导管肠系膜上动脉灌注罂粟碱治疗。结果本组18例NOMI中15例患者治愈;3例有效,介入治疗后腹痛减轻,但仍有局限性的腹膜刺激征,转外科行肠切除治愈;1例10d后死于严重肺部感染导致的呼吸衰竭。结论选择性肠系膜上动脉造影持续经导管肠系膜上动脉灌注罂粟碱是NOMI有效的诊断和治疗方法。