Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Ren Fail. 2009;31(9):802-6. doi: 10.3109/08860220903180624.
Among dialysis patients, acute mesenteric ischemia is mostly caused by non-occlusive mesenteric ischemia (NOMI). There is a very high mortality rate associated with this complication, but prognostic factors associated with NOMI are not well-known.
In this study, we retrospectively reviewed the records of dialysis patients to identify prognostic factors associated with mortality from NOMI. Overall, there were 541 patients on hemodialysis (HD) and 158 patients on peritoneal dialysis (PD) in our hospital from January 2007 to December 2008. Among these 699 patients, we diagnosed NOMI by surgical and/or radiological criteria. A total of 12 dialysis patients (9 on HD and 3 on PD) developed NOMI during the study period.
The incidence of NOMI was 1.04% per patient-year for all dialysis patients (0.95% for HD and 1.35% for PD patients). Most of the 12 patients had chronic hypotension (83.3%, 10/12). Four patients expired following development of NOMI. Our results showed that mortality was significantly higher in patients who were administered a cyclooxygenase (COX) inhibitor prior to ischemia. Hypobicarbonemia during NOMI, which might indicate the severity of hypoperfusion, is also associated with higher mortality.
NOMI is rare in dialysis patients. COX inhibitor administration should be given with caution in long-term hypotensive dialysis patients.
在透析患者中，急性肠系膜缺血主要由非闭塞性肠系膜缺血（NOMI）引起。这种并发症的死亡率非常高，但与 NOMI 相关的预后因素尚不清楚。
在这项研究中，我们回顾性地审查了透析患者的记录，以确定与 NOMI 死亡率相关的预后因素。共有 541 名血液透析（HD）患者和 158 名腹膜透析（PD）患者在我院于 2007 年 1 月至 2008 年 12 月期间接受治疗。在这 699 名患者中，我们通过手术和/或影像学标准诊断为 NOMI。共有 12 名透析患者（9 名 HD 和 3 名 PD）在研究期间发生了 NOMI。
所有透析患者的 NOMI 发生率为每患者每年 1.04%（HD 患者为 0.95%，PD 患者为 1.35%）。大多数 12 名患者有慢性低血压（83.3%，10/12）。4 名患者在发生 NOMI 后死亡。我们的结果表明，在发生缺血前接受环氧化酶（COX）抑制剂治疗的患者中，死亡率明显更高。NOMI 期间的低碳酸氢盐血症，可能表明灌注不足的严重程度，也与更高的死亡率相关。
NOMI 在透析患者中很少见。应谨慎在长期低血压的透析患者中使用 COX 抑制剂。
