老年人缺血性肠病36例临床分析

缺血性肠病好发于老年人,因常无典型的临床表现,故误诊、漏诊及病死率高.本文就我院2001年5月至2008年5月收治的36例患者进行回顾性分析,分析其临床特点.     

缺血性肠病与心脑血管病变

1 缺血性肠病缺血性肠病在我国常见,是由各种原因引起肠道供血不足而形成的一组综合征,可表现为从轻的、可逆性的肠缺血到肠梗塞和肠坏疽,临床上分成急性和慢性两种类型,慢性缺血性肠病包括腹绞痛、腹腔动脉压迫综合征,急性缺血性肠病包括肠系膜上动脉栓塞和血栓形成、急性非肠系膜血管阻塞性肠梗塞、肠系膜静脉血栓形成和缺血性结肠炎,其临床表     

缺血性肠病的诊断(附11例报告)

缺血性肠病是一种由于结肠肠壁血液灌注不良或回流受阻所致的结肠缺血性疾病,我科1999～2002年共收治11例,现将其诊断总结如下。1 资料与方法 全组11例,男7例,女4例,年龄35～82岁,平均65.6岁,有高血压、冠心病者5例,陈旧前壁心肌梗死史1例,心房颤动2例,糖尿病1例,脑梗死1     

缺血性肠病的回顾性分析

缺血性肠病是指由于肠系膜动脉或静脉阻塞导致的一种少见急腹症 ,多发生于老年人 ,早期诊断困难 ,病情发展迅速 ,病死率较高。随着人口的老龄化 ,该病的发病率有增高趋势 ,为减少误诊误治 ,现将 1985年～ 2 0 0 1年间在我院确诊的缺血性肠病患者 32例进行回顾性分析。一、临床资料1.一般资料 :本组 32例中 ,男 2 2例 ,女 10例 ,年龄 38～ 82岁 ,平均 6 5 .6岁。肠系膜上动脉缺血 2 2例 (6 8.8% ) :其中栓塞 13例 ,血栓形成 9例 ;合并有高血压、冠心病 15例 ,心瓣膜病 6例 ,同时伴心房纤颤 8例、脑梗死 3例。肠系膜静脉血栓形成 9例 (2 8.1% …     

阵发性睡眠性血红蛋白尿并发缺血性肠病临床特点分析

阵发性睡眠性血红蛋白尿症（paroxysmal nocturnal hemoglobinuria,PNH）是一种罕见的获得性造血干细胞疾病。PNH胃肠道受累非常少见。本研究旨在总结和分析PNH并发缺血性肠病的临床特点。收集并总结自2010年1月至2020年12月在北京协和医院诊断的6例PNH 并发缺血性肠病患者的临床资...     

缺血性肠病介入治疗一例

正1病例介绍患者,男,63岁,因"反酸烧心1年,伴腹痛腹泻1周"于2016-09-26就诊于天津中医药大学第一附属医院。患者自诉近一年体重下降约15 kg。1周前因劳累、情绪波动出现脐周疼痛,餐后尤甚,大便5~6次/d,最多可达10次/d,大便质稀,无黏液脓     

老年缺血性肠病4例误诊分析

我院急诊科 1998年 9月至 1999年 9月收治老年人急性肠系膜血管闭塞症 4例 ,均因无法早期诊断 ,痛失抢救时机而死亡 ,报道如下。1　临床资料1.1　一般资料　死亡 4例中男女各 2例 ,平均年龄 69岁 (64～ 78岁 ) ,分别误诊为急性胃炎 1例 ,急性阑尾炎 1例 ,麻痹性肠梗阻 1例 ,腹膜炎休克 1例。最后确诊方法为剖腹探查 1例 ,广泛小肠切除 1例 ,肠系膜上动脉多普勒检查 1例 ,血便并腹穿血性液 1例。1.2　典型病例例 1,男 ,64岁 ,主因腹痛 2ｈ伴呕吐 1次来诊 ,既往高血压史 2 5年 ,5年前患脑梗死治愈 ,半年来间断发作的食后腹痛、腹胀 ,服助消化…     

老年功能性肠病与高血压缺血性肠病的相关性

目的探讨老年人高血压并存功能性肠病(FBD)与高血压靶器官损害并存缺血性肠病(IC)内在联系的机制。方法收集老年高血压并存FBD 38例为FBD组,老年高血压并存IC 25例作为IC组,无FBD及IC老年患者44例作为对照组,入选者均详细记录病史,测量身高、体重,计算体质指数(BMI)、血压、心脏超声,并测定血肌酐(Cr);测定尿微量白蛋白(UAE)含量及肾小球滤过率(GFR);计算左室重量指数(LVMI);观察高血压靶器官损害即:高血压并存临床情况,进行各组的临床指标比较分析。分析各组患者应用聚合酶链反应和限制性片段长度多态性方法测定ACE基因I/D多态性以及CMA基因A/G多态性。结果 IC组的Cr、GFR、LVD、LVPWT、LVMI、UAE等临床指标既高于FBD组又高于对照组(P<0.05),IC组的高血压临床并存情况总检出率为88%,高于FBD组的60.53%(P<0.05),其中IC组的外周血管疾病检出率为12%,高于FBD组(P<0.035),IC组的ACE基因D等位基因频率为54%,分别高于FBD组的34.21%(P<0.05)和对照组的34%(P<0.05),IC组的CMA基因GG基因型频率为28%,高于对照组的4.54%(P<0.05),IC组的G等位基因频率为52%,分别高于FBD组的34.21%(P<0.05)和对照组的25%(P<0.05)。结论老年人高血压并存FBD可能是IC的预警疾病,ACE基因I/D多态性以及CMA基因A/G多态性可能与老年人高血压并存肾功能减退、脑血管疾病、心脏结构异常、FBD、IC等器官功能损害相关。     

Factors predicting poor prognosis in ischemic colitis

AIM: To determine the clinical, analytical and endoscopic factors related to ischemic colitis (IC) severity. METHODS: A total of 85 patients were enrolled in a retrospective study from January 1996 to May 2004. There were 53 females and 32 males (age 74.6 f33 9.4 years, range 45-89 years). The patients were diagnosed as IC. The following variables were analyzed including age, sex, period of time from the appearance of symptoms to admission, medical history, medication, stool frequency, clinical symptoms and signs, blood tests (hemogram and basic biochemical profile), and endoscopic findings. Patients were divided in mild IC group and severe IC group (surgery and/or death). Qualitative variables were analyzed using chi-square test and parametric data were analyzed using Student's t test (P < 0.05). RESULTS: The mild IC group was consisted of 69 patients (42 females and 27 males, average age 74.7±12.4 years). The severe IC group was composed of 16 patients (11 females and 5 males, average age of 73.8±12.4 years). One patient died because of failure of medical treatment (no surgery), 15 patients underwent surgery (6 after endoscopic diagnosis and 9 after peroperatory diagnosis). Eight of 85 patients (9.6%) died and the others were followed up as out-patients for 9.6±3.5 mo. Demographic data, medical history, medication and stool frequency were similar in both groups (P > 0.05). Seriously ill patients had less hematochezia than slightly ill patients (37.5% vs 86.9%, P = 0.000). More tachycardia (45.4% vs 10.1%, P = 0.011) and a higher prevalence of peritonism signs (75% vs 5.7%, P = 0.000) were observed in the severe IC group while the presence and intensity of abdominal pain were similar between two groups. Two patients with severe IC had shock when admitted. Regarding analytical data, more seriously ill patients were found to have anemia and hyponatremia than the mildly ill patients (37.5% vs 10.1%, P = 0.014 and 46.6% vs 14.9%, P = 0.012, respectively). Stenosis was the only endoscopic finding that appeared more frequently in seriously ill patients than in slightly ill patients (66.6% vs 17.3%, P = 0.017). CONCLUSION: The factors that can predict poor prognosis of IC are the absence of hematochezia, tachycardia and peritonism, anemia and hyponatremia and stenosis.     

Colonoscopy-induced ischemic colitis in patients without risk factors

Ischemic colitis is the most common form of intestinal ischemia.It is a condition that is commonly seen in the elderly and among individuals with risk factors for ischemia.Common predisposing conditions for ischemic colitis are major vascular occlusion,small vessel disorder,shock,some medications,colonic obstructions and hematologic disorders.Ischemic colitis following colonoscopy is rare.Here,we report two cases of ischemic colitis after a routine screening colonoscopy in patients without risk factors for ischemia.     

The influence of uremia and immunosuppression on an animal model for ischemic colitis

Up to 1 percent of renal transplant recipients have been reported to develop ischemic colitis. Immunosuppressive agents and uremia have been implicated in the development of this complication, but their exact relationship remains unclear. A rat model was developed to determine the effects of uremia alone and in combination with immunosuppression on the development of ischemic colitis. Seventy-six animals were included in the study. Uremia and ischemic colitis were induced surgically. The immunosuppressive agents azathioprine and methylprednisolone were administered for 72 hours after a colonic segment was devascularized in chronically uremic rats. One-way analysis of variance (ANOVA) showed that uremia potentiates colonic ischemia significantly (4.09 cm² vs 1.25 cm²,P<0.03). The addition of parenteral steroids (methylprednisolone) or azathioprine alone and in combination did not potentiate or reduce this ischemic process in uremic animals. Each of these factors alone is commonly present in the renal transplant population and can contribute to the development of potentially fatal ischemic colitis. Supported by Biomedical Research Support Grant RR 05374 from the Division of Research Facilities and Resources, National Institutes of Health, Washington, D.C.     

Mortality from ischemic colitis

Thirty-nine hospital-based cases of ischemic colitis were reviewed. There were 18 males and 21 females. Average age was 68.7 years (range, 18 to 92 years). Associated diseases among 13 patients younger than 65 included renal failure in seven patients and hematologic, vasculitic, or collagen vascular diseases in four. In 26 patients 65 or older, congestive heart failure was seen in 13, vascular disease in eight, and previous aortic surgery in four. Nineteen patients were treated nonsurgically and 8 died (42 percent mortality). Twenty patients (51 percent) underwent surgery: 18 had resection with colostomy or ileostomy and two had resection with reanastomosis; one patient underwent laparotomy followed by second-look exploration without resection. Thirteen of the 20 surgical patients died (65 percent mortality). Both patients who underwent reanastomosis died of sepsis. The data show a close association between ischemic colitis and a number of serious systemic diseases including renal failure, arteriosclerotic heart and vascular disease, and hematologic, vasculitic, and connective-tissue disease. A predilection for the right colon and sigmoid colon and splenic flexure was seen. A formidable mortality rate (53 percent) was found among patients treated both surgically and nonsurgically. Read at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17 1988.     

他汀类药物与缺血性脑血管病

除降脂外,他汀类药物还具有广泛的多效性.文章对他汀类药物在缺血性脑血管病防治中的多效性进行了综合和归纳.     

缺血性肠炎发病危险因素及炎症指标相关性分析

目的:探讨缺血性肠炎(IC)临床特点、发病危险因素及炎症指标对判断预后的意义,为早期诊断、早期治疗、判断预后提供依据.方法:选取2008年1月-2020年2月经北京市某三级医院结肠镜及相关检查诊断为IC的患者72例为病例组,选取同期在该院接受健康体检、结肠镜检查未见异常的体检者100例为对照组.将2组的临床资料进行回顾...     

Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis

AIM:To evaluate the clinical outcomes and prognostic factors after intravenous corticosteroids following oral corticosteroid failure in active ulcerative colitis patients.METHODS:Consecutive patients with moderate to severe ulcerative colitis who had been treated with a course of intravenous corticosteroids after oral corticosteroid therapy failure between January 1996 and July 2010 were recruited at Severance Hospital,Seoul,South Korea.The disease activity was measured by the Mayo score,which consists of stool frequency,rectal bleeding,mucosal appearance at flexible sigmoidoscopy,and Physician Global Assessment.We retrospectively evaluated clinical outcomes at two weeks,one month,three months,and one year after the initiation of intravenous corticosteroid therapy.Two weeks outcomes were classified as responders or non-responders.One month,three month and one year outcomes were classified into prolonged response,steroid dependency,and refractoriness.RESULTS:Our study included a total of 67 eligible patients.At two weeks,56(83.6%) patients responded to intravenous corticosteroids.At one month,complete remission was documented in 18(32.1%) patients and partial remission in 26(46.4%).Eleven patients(19.7%) were refractory to the treatment.At three months and one year,we found 37(67.3%) and 25(46.3%) patients in prolonged response,ten(18.2%) and 23(42.6%) patients in corticosteroid dependency,8(14.5%) and 6(11.1%) patients with no response,respectively.Total 9 patients were underwent elective proctocolectomy within 1 year.The duration of oral corticosteroid therapy(> 14 d vs ≤ 14 d,P = 0.049) and lower hemoglobin level(≤ 11.0 mg/dL vs >11.0 mg/dL,P = 0.02) were found to be poor prognostic factors for response at two weeks.For one year outcome,univariate analysis revealed that only a partial Mayo score(≥ 6 vs <6,P = 0.057) was found to be associated with a poor response.CONCLUSION:The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.     

Risk factors associated with the development of ischemic colitis

AIM:To ascertain the role of cardiovascular risk factors,cardiovascular diseases,standard treatments and other diseases in the development of ischemic colitis(IC).METHODS:A retrospective,case-control study was designed,using matched data and covering 161 incident cases of IC who required admission to our hospital from 1998 through 2003.IC was diagnosed on the basis of endoscopic findings and diagnostic or compatible his-tology.Controls were randomly chosen from a cohort of patients who were admitted in the same period and required a colonoscopy,excluding those with diagnosis of colitis.Cases were matched with controls(ratio 1:2),by age and sex.A conditional logistic regression was performed.RESULTS:A total of 483 patients(161 cases,322 con-trols)were included;mean age 75.67±10.03 years,55.9%women.The principal indications for colonos-copy in the control group were lower gastrointestinal hemorrhage(35.4%),anemia(33.9%),abdominal pain(19.9%)and diarrhea(9.6%).The endoscopic findings in this group were hemorrhoids(25.5%),diverticular disease(30.4%),polyps(19.9%)and colorectal cancer(10.2%).The following variables were associated with IC in the univariate analysis:arterial hypertension(P= 0.033);dyslipidemia(P<0.001);diabetes mellitus(P =0.025);peripheral arterial disease(P=0.004);heart failure(P=0.026);treatment with hypotensive drugs(P=0.023);angiotensin-converting enzyme inhibitors;(P=0.018);calcium channel antagonists(P=0.028);and acetylsalicylic acid(ASA)(P<0.001).Finally,the following variables were independently associated with the development of IC:diabetes mellitus[odds ratio(OR)1.76,95%confidence interval(CI):1.001-3.077,P=0.046];dyslipidemia(OR 2.12,95%CI:1.26-3.57,P=0.004);heart failure(OR 3.17,95%CI:1.31-7.68,P=0.01);peripheral arterial disease(OR 4.1,95%CI:1.32-12.72,P=0.015);treatment with digoxin(digitalis)(OR 0.27,95%CI:0.084-0.857,P=0.026);and ASA(OR 1.97,95%CI:1.16-3.36,P=0.012).CONCLUSION:The development of an episode of IC was independently associated with diabetes,dyslipid-emia,presence     

59例缺血性结肠炎临床研究

目的　了解缺血性肠炎的临床表现、内镜特点及其发病机理。方法　所有病例均于症状出现后１ ～１４ 天内行全结肠内镜检查,并于首次检查后两周至四个月内复查肠镜,部分病例取病变粘膜活检,观察其临床特征及内镜下表现特点。结果　经大肠镜检查确诊的５９ 例缺血性结肠炎、不包括两周内曾服用过抗生素者,男２０ 例,女３９ 例,年龄２５～８１ 岁,平均年龄５３－８６ 岁,其中１１ 例为４０ 岁以下的年青人,高峰年龄为６１ ～７０ 岁组,３６ 例患有动脉硬化相关性疾病,１１ 例无可以证明的基础病变,但其中的８ 例有便秘史,３ 例有下腹部手术史,２ 例发生于乙状结肠癌。大部分为一过性炎症型者。临床表现主要为腹痛、血便及腹泻,少数患者有呕吐或恶心：内镜下表现多样化,病变粘膜与正常粘膜界限清楚,多数病变位于左半结肠,无直肠病变者。病理表现无特异性。结论　缺血性结肠炎可以发生于各个年龄组,但以中年以上发病率为高,发病部位多位于血流相对不足的左半结肠,并易发生纤维狭窄。血管因素与肠管因素为致病的重要原因     

缺血性结肠炎与溃疡性结肠炎临床诊断对比分析

目的对比分析缺血性结肠炎及溃疡性结肠炎临床特点与组织病理学的差异,为临床鉴别诊断提供依据。方法收集广西医科大学第一附属医院2010~2013年20例缺血性结肠炎及30例溃疡性结肠炎患者性别、病程、年龄、基础疾病史、临床表现,肠镜结果及病理特点等资料,并进行对比分析。结果缺血性结肠炎发病以60岁以上老年人为主,起病急,病程短,多伴有高血压、糖尿病等基础疾病,溃疡性结肠炎以中青年患者为主,病程长,伴随基础疾病较少见,前者临床表现以腹胀、呕吐多见,后者以黏液血便及里急后重症状较多见。缺血性结肠炎肠镜下病变较少累及直肠,多出现黏膜水肿,溃疡多呈纵行,溃疡性结肠炎常累及直肠,常合并炎性假息肉,溃疡以地图状为主,病变部位呈连续性。病理上,缺血性结肠炎以血管扩张充血、间质水肿及血管壁增厚多见,而炎性细胞浸润及隐窝脓肿较少见。结论结合年龄、既往病史、临床症状及内镜、组织病理学检查结果,有助于缺血性结肠炎与溃疡性结肠炎的鉴别诊断。