Acosta-Mérida María Asunción, Marchena-Gómez Joaquín, Cruz-Benavides Francisco, Hernández-Navarro Juan, Roque-Castellano Cristina, Rodríguez-Méndez Alvaro, Alonso-Alvarado Ayaya, Hernández-Romero Juan
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
Cir Esp. 2007 Mar;81(3):144-9. doi: 10.1016/s0009-739x(07)71286-1.
Suspicion of intestinal necrosis in patients with mesenteric ischemia is mandatory in surgery. Many patients develop massive necrosis after open surgery. However, in some frail, elderly patients, preoperative prediction of massive intestinal necrosis could avoid an unnecessary laparotomy. The aim of this study was to assess predictive factors of massive intestinal necrosis in acute mesenteric ischemia.
We retrospectively evaluated a consecutive sample of 155 patients, 88 men and 67 women, with a mean age of 71.9 years (SD +/- 13.6), who underwent surgery for acute mesenteric ischemia in our institution from 1990 to 2004. Age, sex, clinical features, laboratory findings, and delay to surgery were recorded and assessed as possible risk factors for massive intestinal necrosis. A logistic regression model was used to identify independent prognostic factors.
Of the 155 patients, massive intestinal necrosis was recorded in 48 (31%; 95% CI: 23.4-38.6). A statistically significant association was found between massive intestinal necrosis and age (p = 0.04), previous digoxin use (p = 0.01), shock (p = 0.009), hemoconcentration (hemoglobin levels > 16 g/dL) (p = 0.02), hyperamylasemia (p < 0.001), acidosis (p = 0.012), and alkalosis (p = 0.048). Multiple stepwise logistic regression analysis identified three independent prognostic factors that were significantly associated with a higher risk of massive intestinal necrosis: shock (OR = 3.4; 95% CI: 1.1-10), hemoconcentration (OR = 6; 95% CI: 1.6-22.8), and hyperamylasemia (OR = 4.2; 95% CI: 1.5-12.2).
Massive intestinal necrosis can be observed in at least 25% of patients undergoing surgery for acute mesenteric ischemia. Within the limitations of a retrospective study, the variables of shock, hemoconcentration and elevated serum amylase levels may be considered as independent predictive factors of fatal necrosis of the bowel.
对于肠系膜缺血患者，手术中怀疑肠道坏死是必要的。许多患者在开腹手术后会发生大面积坏死。然而，对于一些体弱的老年患者，术前预测大面积肠道坏死可避免不必要的剖腹手术。本研究的目的是评估急性肠系膜缺血患者大面积肠道坏死的预测因素。
我们回顾性评估了1990年至2004年在我院接受急性肠系膜缺血手术的155例患者的连续样本，其中男性88例，女性67例，平均年龄71.9岁（标准差±13.6）。记录年龄、性别、临床特征、实验室检查结果以及手术延迟时间，并将其作为大面积肠道坏死的可能危险因素进行评估。使用逻辑回归模型确定独立的预后因素。
155例患者中，48例（31%；95%置信区间：23.4 - 38.6）记录有大面积肠道坏死。发现大面积肠道坏死与年龄（p = 0.04）、既往使用地高辛（p = 0.01）、休克（p = 0.009）、血液浓缩（血红蛋白水平>16 g/dL）（p = 0.02）、高淀粉酶血症（p < 0.001）、酸中毒（p = 0.012）和碱中毒（p = 0.048）之间存在统计学显著关联。多步逻辑回归分析确定了三个与大面积肠道坏死风险较高显著相关的独立预后因素：休克（比值比 = 3.4；95%置信区间：1.1 - 10）、血液浓缩（比值比 = 6；95%置信区间：1.6 - 22.8）和高淀粉酶血症（比值比 = 4.2；95%置信区间：1.5 - 12.2）。
在接受急性肠系膜缺血手术的患者中，至少25%可观察到大面积肠道坏死。在回顾性研究的局限性内，休克、血液浓缩和血清淀粉酶水平升高这些变量可被视为肠道致命坏死的独立预测因素。
