Lai Chun-Fu, Chang Wei-Tien, Liang Po-Chin, Lien Wan-Ching, Wang Hsiu-Po, Chen Wen-Jone
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Emerg Med. 2005 Mar;23(2):177-81. doi: 10.1016/j.ajem.2004.05.010.
Pneumatosis intestinalis and hepatic portal venous gas are usually associated with severe intra-abdominal pathologies. As diagnostic technologies advanced, a number of variant etiologies have been identified. We report 2 cases in which pneumatosis intestinalis and hepatic portal venous gas developed after prolonged cardiopulmonary resuscitation (CPR). The pathogenic mechanism was most probably bowel infarction caused by poor mesenteric perfusion during and after CPR. Limited cardiac output during prolonged resuscitation and severe vasoconstriction after large doses of epinephrine and vasopressors might both contribute to the compromised mesenteric perfusion. The risk seems especially high for old patients with severe atherosclerosis. Once it happens, the prognosis is extremely poor. In patients of cardiac arrests receiving prolonged CPR, catastrophic complications like this should be considered in the postresuscitation phase, especially those with multiple risk factors like old age, severe atherosclerosis, and use of large doses of vasoconstrictors.
肠壁积气和肝门静脉积气通常与严重的腹腔内病变相关。随着诊断技术的进步，已发现一些不同的病因。我们报告2例在长时间心肺复苏（CPR）后出现肠壁积气和肝门静脉积气的病例。其发病机制很可能是CPR期间及之后肠系膜灌注不良导致的肠梗死。长时间复苏期间的心输出量受限以及大剂量肾上腺素和血管加压药使用后的严重血管收缩可能都导致了肠系膜灌注受损。对于患有严重动脉粥样硬化的老年患者，这种风险似乎尤其高。一旦发生，预后极差。在接受长时间CPR的心脏骤停患者中，复苏后阶段应考虑这种灾难性并发症，尤其是那些具有多种危险因素如老年、严重动脉粥样硬化和使用大剂量血管收缩药的患者。
