Ullery Brian S, Boyko Andrew T, Banet Gerald A, Lewis Lawrence M
Division of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
J Emerg Med. 2004 Jul;27(1):1-5. doi: 10.1016/j.jemermed.2003.11.022.
We described signs and symptoms of patients who present to an Emergency Department (ED) with intestinal ischemia and compare clinical course and outcomes of patients with mesenteric vs. colonic ischemia. We retrospectively reviewed charts of 100 patients discharged from our hospital with an ICD-9 code for mesenteric or intestinal ischemia. Compared to patients with mesenteric ischemia, those with colonic ischemia were older (61 vs. 77 years, respectively; p = 0.002), were more likely to present with gastrointestinal (GI) bleeding (11 vs. 90%, respectively; p < 0.001), but were less likely to report abdominal pain as their primary complaint (89% vs. 10%, respectively; p < 0.001) or to receive a correct ED diagnosis (75% vs. 9%, respectively; p < 0.001). Patients with colonic ischemia frequently presented with gross GI bleeding, and were often misdiagnosed in the ED. For timely treatment of a potentially serious condition, the diagnosis of intestinal ischemia should be considered in ED patients presenting with GI bleeding and appropriate risk factors.
我们描述了因肠道缺血而就诊于急诊科（ED）的患者的体征和症状，并比较了肠系膜缺血与结肠缺血患者的临床病程及预后。我们回顾性分析了我院出院的100例患有肠系膜或肠道缺血且ICD - 9编码的患者病历。与肠系膜缺血患者相比，结肠缺血患者年龄更大（分别为61岁和77岁；p = 0.002），更易出现胃肠道（GI）出血（分别为11%和90%；p < 0.001），但以腹痛作为主要主诉的可能性更小（分别为89%和10%；p < 0.001），且获得急诊科正确诊断的可能性也更小（分别为75%和9%；p < 0.001）。结肠缺血患者常出现明显的胃肠道出血，且在急诊科常被误诊。为及时治疗潜在的严重疾病，对于出现胃肠道出血且有适当风险因素的急诊科患者，应考虑肠道缺血的诊断。
