胃缺血的发病机制、诊断和治疗。
Pathogenesis, diagnosis, and management of gastric ischemia.
机构信息
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
出版信息
Clin Gastroenterol Hepatol. 2014 Feb;12(2):246-52.e1. doi: 10.1016/j.cgh.2013.07.025. Epub 2013 Aug 3.
BACKGROUND & AIMS: Gastric ischemia is infrequently reported in the medical literature and under-recognized clinically and histopathologically. Various medical terms are used to describe gastric ischemia. We define and review the pathogenesis, diagnosis, and management of gastric ischemia.
METHODS
We describe 6 cases of gastric ischemia. We discuss features of the gastric vascular supply and review literature on this disorder.
RESULTS
Gastric ischemia results from diffuse or localized vascular insufficiency caused by etiologies such as systemic hypotension, vasculitis, or disseminated thromboembolism. The disorder is managed by fluid resuscitation, nasogastric tube placement (for intermittent air and fluid aspiration, to prevent or reduce gastric distention), aggressive acid reduction (via intravenous administration of proton pump inhibitors), and selective use of broad-spectrum antibiotics for patients with sepsis or gastric pneumatosis.
CONCLUSIONS
Gastric ischemia has a poor prognosis. Early diagnosis is required for appropriate patient management.
背景与目的
胃缺血在医学文献中报道较少，临床上和组织病理学上认识不足。有多种医学术语用于描述胃缺血。我们定义并回顾了胃缺血的发病机制、诊断和治疗方法。
方法
我们描述了 6 例胃缺血病例。我们讨论了胃血管供应的特点，并回顾了关于这种疾病的文献。
结果
胃缺血是由低血压、血管炎或弥散性血栓栓塞等病因引起的弥漫性或局部性血管功能不全所致。该疾病通过液体复苏、放置鼻胃管（用于间歇性空气和液体抽吸，以预防或减少胃扩张）、积极的酸减少（通过静脉内给予质子泵抑制剂）以及对败血症或胃积气患者选择性使用广谱抗生素来治疗。
结论
胃缺血预后不良。需要早期诊断以进行适当的患者管理。
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