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镰状细胞病并发症的急诊医学管理:基于证据的更新

Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update.

作者信息

Simon Erica, Long Brit, Koyfman Alex

机构信息

Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.

Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.

出版信息

J Emerg Med. 2016 Oct;51(4):370-381. doi: 10.1016/j.jemermed.2016.05.042. Epub 2016 Aug 20.

Abstract

BACKGROUND

Sickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention.

OBJECTIVE

Our aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications.

DISCUSSION

SCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease. Emergency physicians must recognize acute manifestations of SCD in order to deliver timely management and determine patient disposition.

CONCLUSIONS

A comprehensive review of the emergency department management of acute SCD complications is provided. Comprehensive understanding of these aspects of SCD can assist physicians in expediting patient evaluation and treatment, thus decreasing the morbidity and mortality associated with this hemoglobinopathy.

摘要

背景

在美国,镰状细胞病(SCD)影响着约10万名个体。由于在脱氧条件下血红蛋白分子的结构构象发生改变,SCD患者易患多种后遗症,其中许多需要急性干预。

目的

我们的目的是为急诊医生提供关于SCD并发症诊断和管理的循证更新。

讨论

SCD患者因脑血管意外、急性胸综合征、急性血管闭塞性疼痛危象、SCD相关多器官衰竭、胆囊炎、急性肝内胆汁淤积、急性镰状肝危象、急性肝脾滞留、阴茎异常勃起和肾脏疾病而出现显著的发病率和死亡率。急诊医生必须认识到SCD的急性表现,以便及时进行管理并确定患者的处置方式。

结论

本文对急诊科急性SCD并发症的管理进行了全面综述。对SCD这些方面的全面理解有助于医生加快患者评估和治疗,从而降低与这种血红蛋白病相关的发病率和死亡率。

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