透過您的圖書館登入
IP:3.235.75.229

摘要


背景及目的:急性腸繫膜梗塞是一種具有高死亡率的血管性急症。本研究之目的在(l)分析急性腸繫膜梗塞的臨床表現,以及(2)探討該急症的預後因子。方法:回溯性分析自1976年8月至2002年8月間,因上腸繫膜梗塞至本院急診就醫且經手術證實該診斷之40位患者的臨床症狀、徵候、實驗室檢查值及電腦斷層發現。並以多變項分項找出影響患者存活與否的獨立預後因子。結果:患者之年齡全部都大於50歲(100%),其平均年齡為74.6±9.6歲,男性患者較多(佔78%)。大部分患者具有心血管疾病或癌症(68%),並具有腹痛(85%)及腸蠕動音減少(58%)之徵候;白血球增高(78%)、血紅素下降(70%)、尿素氮值增高(93%)、肌肝酸值增高(78%)、代謝性酸中毒(60%)及AST值增高(58%)之實驗室檢查異常;腸管擴大(82%)、腸壁增厚(82%)、腹水(62%)及腸壁內含氣體(59%)之電腦斷層發現。患者的死亡率為70%,影響患者死亡率之獨立危險因子為「休克」(差異比值9.0:95%信賴區問1.6至49.4)。結論:年老且具有血管疾病或癌症之患者若發生腹部疼痛或腫脹之情形時,須高度考慮急性腸繫膜梗塞。電腦斷層對其診斷十分有幫助,宜善加利用。在現代醫學中,急性腸繫膜梗塞之死亡率仍然很高,休克是否存在是影響患者存活的重要因子。

並列摘要


Background and aims: Acute mesenteric infarction is a life-threatening vascular emergency with high mortality. The aims of this study were to investigate the clinical presentations of patients with acute mesenteric infarction, and to identify the independent prognostic factors of this vascular emergency. Methods: From August 1996 to August 2002, forty patients with acute mesenteric infarction called on our emergency room and underwent surgical intervention to confirm and treat their diseases. We retrospectively analyze their clinical symptoms, signs, results of laboratory tests and computed tomography. Additionally, a multivariate analysis was applied to search the independent factors for the outcomes of patients. Results: All the patients were more than 50 years old (100%) The mean age of them was 74.6±9.6 years. Acute mesenteric infarction predominated in male subjects (78%). The majority of the cases had underlying diseases (68%) and presented with abdominal pain (85%), abdominal fullness (65%); abdominal tenderness (85%), abdominal distension (63%), hypoactive bowel sounds (58%); leukocytosis (78%), anemia (70%), increased blood urea nitrogen (93%), serum creatinine (78%) and AST levels (58%) and metabolic acidosis (60%); dilated bowel loops (82%), thickened bowel walls (82%), ascites (62%) and pneumatosis intestinalis (59%). The mortality rate of our cases was 70%. Shock was the only independent risk factors for mortality (odds ratio: 9.0; 95% confidence intervals: 1.6-49.4). Conclusions: Acute mesenteric infarction should be suspected when aged patients who have underlying diseases present with abdominal pain or fullness. Computed tomography is useful in the diagnosis of acute mesenteric infarction. In modern medicine, the mortality of acute mesenteric infarct is still very high. Shock is the only independent factor predicting high mortality.

延伸閱讀