From the Department of Surgery (J.E.A., I.E.B., K.I., C.S.C., J.M.G.), and Department of Pathology, (K.A.O.), University of California Davis Health, Sacramento, California.
J Trauma Acute Care Surg. 2018 Jun;84(6):885-892. doi: 10.1097/TA.0000000000001855.
Data suggest that methamphetamine may increase the risk of nonocclusive mesenteric ischemia (NOMI). We describe patterns of presentation and outcomes of patients with methamphetamine use who present with NOMI to a single institution.
This is an observational study of patients from January 2015 to September 2017 with methamphetamine use who presented with NOMI at an academic medical center in Northern California. We summarize patient comorbidities, clinical presentation, operative findings, pathologic findings, hospital course, and survival.
Ten patients with methamphetamine use and severe NOMI were identified. One patient was readmitted with a perforated duodenal ulcer, for a total of 11 encounters. Most presented with acute (n = 3) or acute-on-chronic (n = 4) abdominal pain. Distribution of ischemia ranged from perforated duodenal ulcer (n = 3), ischemia of the distal ileum (n = 1), ischemia of entire small bowel (n = 2), and patchy necrosis of entire small bowel and colon (n = 5). Six patients died, three within 1 week of admission and three between 3 months and 8 months.
Methamphetamine use may be associated with significant microvascular compromise, increasing the risk of mesenteric ischemia. Providers in areas with high prevalence of methamphetamine use should have a high index of suspicion for intestinal ischemia in this patient population. Patients with methamphetamine use admitted for trauma or other pathology may be at particular risk of ischemia and septic shock, especially in the setting of dehydration. Use of vasoconstrictors in this patient population may also exacerbate intestinal ischemia.
Therapeutic Case series study, level V.
有数据表明，冰毒可能会增加非闭塞性肠系膜缺血（NOMI）的风险。我们描述了在北加州一家学术医疗中心就诊的、有冰毒使用史并伴有 NOMI 的患者的表现模式和结局。
这是一项观察性研究，纳入了 2015 年 1 月至 2017 年 9 月期间在北加州一家学术医疗中心就诊的、有冰毒使用史且伴有 NOMI 的患者。我们总结了患者的合并症、临床表现、手术发现、病理发现、住院过程和生存率。
确定了 10 例有冰毒使用史且严重 NOMI 的患者。其中 1 例因穿孔性十二指肠溃疡再次入院，共 11 次就诊。大多数患者以急性（n = 3）或慢性加重性（n = 4）腹痛就诊。缺血的分布范围从穿孔性十二指肠溃疡（n = 3）、回肠末端缺血（n = 1）、整个小肠缺血（n = 2），到整个小肠和结肠的斑片状坏死（n = 5）。6 例患者死亡，其中 3 例在入院后 1 周内死亡，3 例在 3 个月至 8 个月之间死亡。
冰毒使用可能与严重的微血管损伤有关，增加了肠系膜缺血的风险。在冰毒使用流行地区，此类患者群体发生肠道缺血的可能性较高，临床医生应保持高度警惕。因创伤或其他疾病而入院的冰毒使用者可能特别容易发生缺血和感染性休克，尤其是在脱水的情况下。在该患者群体中使用血管收缩剂也可能加重肠道缺血。
治疗性病例系列研究，5 级。
