Acosta Stefan, Block Tomas, Björnsson Steinarr, Resch Timothy, Björck Martin, Nilsson Torbjörn
Vascular Center, Malmö University Hospital, Malmö, Sweden.
J Emerg Med. 2012 Jun;42(6):635-41. doi: 10.1016/j.jemermed.2011.03.036. Epub 2011 Dec 1.
Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.
To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.
Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.
The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).
Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.
急性肠系膜上动脉（SMA）闭塞可导致急性肠缺血，且死亡率高。早期诊断常被漏诊，需要强调导致诊断延迟的混杂因素。
确定急性SMA闭塞患者入院时潜在的诊断性实验室陷阱。
2005年至2009年的4年间，从医院登记册中识别出55例急性SMA闭塞患者。
中位年龄为76岁；78%为女性。53%的患者闭塞为栓塞性，47%为血栓形成性。入院时，9/19（47%）例栓塞性闭塞患者的肌钙蛋白I高于急性缺血性心肌损伤的临床决策水平（>0.06μg/L）。分别在12/45和13/27的患者中发现胰腺淀粉酶升高和血浆乳酸正常。肌钙蛋白I（TnI）高于临床决策水平与普通外科医生转诊至内科专家（p=0.011）或心脏病专家（p=0.024）的高频率相关。98%的患者在计算机断层血管造影后确诊。总体院内死亡率为33%。尝试肠血管重建（n=43；p<0.001），血管手术完成控制频率为95%，与较高的生存率相关，而转诊至心脏病专家与较高的死亡率相关（p=0.018）。
急性SMA闭塞中TnI升高很常见，且转诊至心脏病专家与不良结局相关。胰腺淀粉酶升高和血浆乳酸值正常也是急性SMA闭塞患者入院时的潜在陷阱。
