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肠系膜急症的急性处理:针对问题制定解决方案。

Acute management of mesenteric emergencies: Tailoring the solution to the problem.

机构信息

Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.

出版信息

Semin Vasc Surg. 2023 Jun;36(2):234-249. doi: 10.1053/j.semvascsurg.2023.04.007. Epub 2023 Apr 25.

Abstract

Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.

摘要

急性肠系膜缺血(AMI)是一种危及生命的问题,可导致死亡、多器官衰竭和严重的营养障碍。尽管 AMI 是急性腹痛急症的罕见原因,每 10000 人中发病率为 1 至 2 人,但发病率和死亡率很高。动脉栓塞病因构成近一半的 AMI,以突然出现严重腹痛为最常见症状。动脉血栓形成是 AMI 的第二大常见原因,其表现与动脉栓塞性 AMI 相似,尽管由于解剖差异,通常更为严重。静脉阻塞性 AMI 是第三种最常见的原因,与隐匿性腹痛发作有关。每个患者都是独特的,治疗方案应根据他们的个体需求量身定制。这可能包括考虑患者的年龄、合并症和整体健康状况,以及他们的偏好和个人情况。建议采用多学科方法,由外科医生、介入放射科医生和重症监护医生等不同领域的专家参与,以获得最佳结果。为 AMI 制定最佳治疗方案可能面临的挑战包括诊断延迟、专业护理资源有限,或某些干预措施因患者因素而不太可行。解决这些挑战需要采取积极主动和协作的方法,定期审查和调整治疗方案,以确保每个患者获得最佳结果。

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