Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
J Visc Surg. 2019 Oct;156(5):405-411. doi: 10.1016/j.jviscsurg.2019.01.007. Epub 2019 Feb 10.
Acute mesenteric ischemia (AMI) is associated with a mortality of 60-80%. Early diagnosis and rapid treatment have a decisive influence on therapy. The aim of this study was to evaluate the prognostic value of AMI markers on mortality, in order to better anticipate the clinical course and to initiate therapeutic steps at an early stage.
An analysis from our prospective database of 302 consecutive patients with AMI who were treated surgically in the Department of General Surgery between February 2003 and October 2014 was performed. Uni- and multivariate analysis of risk factors for mortality have been performed in the total cohort and in two subgroups according to their stay in intensive care unit (ICU) at the time of AMI diagnosis.
Of the 302 patients with AMI, 115 were in ICU at the time of diagnosis. Totally, 203 patients underwent computed tomography scan (CT-scan) of the abdomen for diagnosis and 68% of them showed specific signs of AMI. A total of 63 (21%) embolectomies were performed during the surgical procedure. The post-operative mortality rate was 68% (204 patients). Among survivors, 85 (87%) patients developed a short bowel syndrome in the post-operative course. Multivariate analysis showed a significant association between mortality and preoperative lactate>3mmol/L, C-reactive protein>100mg/L and ICU stay at the time of AMI diagnosis.
Mortality of patients with AMI remains high. Elevated lactate, elevated C-reactive protein and ICU stay are factors associated with increased mortality. Their presence in a patient with suspicion of AMI should trigger a multidisciplinary management in emergency.
急性肠系膜缺血（AMI）的死亡率为 60-80%。早期诊断和快速治疗对治疗有决定性影响。本研究旨在评估 AMI 标志物对死亡率的预后价值，以便更好地预测临床过程，并在早期阶段启动治疗措施。
对 2003 年 2 月至 2014 年 10 月期间在普通外科接受手术治疗的 302 例连续 AMI 患者的前瞻性数据库进行分析。在总队列中和根据 AMI 诊断时入住重症监护病房（ICU）的两个亚组中，对死亡率的危险因素进行了单变量和多变量分析。
302 例 AMI 患者中，115 例在诊断时入住 ICU。共有 203 例患者接受腹部 CT 扫描（CT 扫描）以明确诊断，其中 68%的患者出现 AMI 的特异性征象。共有 63 例（21%）患者在手术过程中进行了血栓切除术。术后死亡率为 68%（204 例）。幸存者中，85 例（87%）患者在术后发生短肠综合征。多变量分析显示，术前血乳酸>3mmol/L、C 反应蛋白>100mg/L 和 AMI 诊断时入住 ICU 与死亡率显著相关。
AMI 患者的死亡率仍然很高。乳酸升高、C 反应蛋白升高和 ICU 入住与死亡率增加相关。在怀疑 AMI 的患者中出现这些情况应触发紧急情况下的多学科管理。
