Liu Dafang, Ye Yingjiang, Xie Qiwei, Yin Mujun, Yang Xiaodong, Liang Bin, Wang Shan
Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China.
Department of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jul 25;20(7):787-791.
To explore the predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases and its significance for the timing of exploratory laparotomy.
This retrospective study enrolled 63 patients diagnosed as acute mesenteric vascular occlusive diseases at Peking University People's Hospital between July 1995 and June 2015. Univariate analysis and multivariate logistic regression analysis were used to identify predictive factors for intestinal necrosis.
Of 63 patients, 39 were male and 24 were female, with a mean age of (58.8±12.7)(31 to 82) years. The overall rate of intestinal necrosis was 46.0%(29/63). Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (χ=5.908, P=0.015). In univariate analysis, the predictive factors of intestinal necrosis were systemic inflammatory reactive syndrome (SIRS) (χ=18.535, P=0.000), shock (χ=7.775, P=0.007), peritoneal irritation sign (χ=11.533, P=0.001), changes of intestinal wall and blood signals on ultrasound or CT scans (χ=14.344, P=0.000), international normalized ratio(INR) (prothrombin time) ≥1.2 (χ=4.498, P=0.034), D-dimer ≥1 000 g/L(χ=6.680, P=0.010), low-density lipoprotein ≥270 U/L (χ=6.513, P=0.011), serum albumin <35 g/L (χ=3.914, P=0.048), blood urea nitrogen ≥6.2 mmol/L (χ=11.377, P=0.000), pH values <7.35 (χ=15.887, P=0.000), blood lactate ≥2 mmol/L(χ=17.134, P=0.000), base excess <-1.0 mmol/L (χ=6.674, P=0.010). According to multivariate logistic regression analysis, SIRS(OR=28.945, 95%CI:2.294 to 365.199, P=0.009), pH values <7.35(OR=13.174, 95%CI:1.157 to 150.027, P=0.038), changes of intestinal wall and blood signals on ultrasound or CT scans(OR=4.857, 95%CI:1.110 to 21.253, P=0.036) were independent predictive factors of intestinal necrosis in patients with acute mesenteric vascular occlusive diseases.
Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis. When patients with acute mesenteric vascular occlusive diseases are found to have acidosis, SIRS and changes of intestinal wall and blood signals on ultrasound or CT scans, surgeons should be alert to the occurrence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management.
探讨急性肠系膜血管闭塞性疾病肠坏死的预测因素及其对剖腹探查时机的意义。
本回顾性研究纳入了1995年7月至2015年6月间北京大学人民医院诊断为急性肠系膜血管闭塞性疾病的63例患者。采用单因素分析和多因素logistic回归分析来确定肠坏死的预测因素。
63例患者中，男性39例，女性24例，平均年龄（58.8±12.7）（31至82）岁。肠坏死总发生率为46.0%（29/63）。发生肠坏死的患者预后较未发生肠坏死的患者差（χ=5.908，P=0.015）。单因素分析中，肠坏死的预测因素有全身炎症反应综合征（SIRS）（χ=18.535，P=0.000）、休克（χ=7.775，P=0.007）、腹膜刺激征（χ=11.533，P=0.001）、超声或CT扫描显示肠壁及血流信号改变（χ=14.344，P=0.000）、国际标准化比值（INR）（凝血酶原时间）≥1.2（χ=4.498，P=0.034）、D-二聚体≥1000μg/L（χ=6.680，P=0.010）、低密度脂蛋白≥270U/L（χ=6.513，P=0.011）、血清白蛋白<35g/L（χ=3.914，P=0.048）、血尿素氮≥6.2mmol/L（χ=11.377，P=0.000）、pH值<7.35（χ=15.887，P=0.000）、血乳酸≥2mmol/L（χ=17.134，P=0.000）、碱剩余<-1.0mmol/L（χ=6.674，P=0.010）。多因素logistic回归分析显示，SIRS（OR=28.945，95%CI：2.294至365.199，P=0.009）、pH值<7.35（OR=13.174，95%CI：1.157至150.027，P=0.038）、超声或CT扫描显示肠壁及血流信号改变（OR=4.857，95%CI：1.110至21.253，P=0.036）是急性肠系膜血管闭塞性疾病患者肠坏死的独立预测因素。
急性肠系膜血管闭塞性疾病中的肠坏死提示预后不良。当急性肠系膜血管闭塞性疾病患者出现酸中毒、SIRS以及超声或CT扫描显示肠壁及血流信号改变时，外科医生应警惕肠坏死的发生，应及时行剖腹探查以采取恰当的处理措施。
