肠系膜上静脉血栓形成:切勿贻误诊治时机

目的探讨肠系膜上静脉血栓形成(superior mesenteric venous thrombosis,SMVT)的早期诊断方法及最佳诊治时机和策略。方法回顾分析我院2010年3月—2013年10月收治的42例SMVT的临床资料,按病程分为急性组19例和慢性组23例,分析两组临床表现、诊治经过及治疗效果。结果 42例均以腹痛为主要表现,急性组表现为上腹部、脐周及全腹部绞痛或胀痛,慢性组表现为腹部及脐周胀痛,且急性组血白细胞、体温显著高于慢性组(P均0.001)。两组均经计算机断层X线血管造影(CTA)检查确诊,根据病情分别行小肠切除术、经肠系膜上动脉置管溶栓术及药物抗凝治疗等,急性组治疗有效率为94.8%,病死率为5.2%,慢性组治疗有效率为95.7%,病死率为4.3%。结论 CTA是确诊SMVT的首选手段,并能明确剖腹探查术的适应证。通过有效措施促进侧支循环建立,防止远期血栓复发及门静脉高压相关并发症,是SMVT的主要治疗策略。     

急性肠系膜静脉血栓形成19例诊治探讨

目的:探讨急性肠系膜静脉血栓形成(AMVT)的早期诊断及治疗方法.方法:回顾性分析我院收治的19 例AMVT的临床资料.结果:19均表现为中～重度腹痛,其中恶心、呕吐17例,便血10例,腹胀2例.血常规和腹部X线平片检查均未见明显异常,13例行彩超检查,11例行腹部CT扫描均提示异常.本组15例经手术治疗、4例经B超和CT扫描明确诊断.18例治愈,其中15例手术治愈,2例行外周静脉溶栓,1例经肠系膜上动脉行介入溶栓;1例合并胰腺癌和恶病质者放弃治疗后死亡.本组并发短肠综合征、下肢深静脉血栓形成各1例.结论: 彩超和CT扫描早期确诊AMVT后应立即行适当抗凝、溶栓治疗或手术治疗,术后配合抗凝可取得较好的临床效果.     

急性肠系膜上静脉血栓形成的观察及护理16例

急性肠系膜静脉血栓（SMVT）是一种危重急腹症。病死率达32％，约占肠缺血疾病的15％～20％。因其临床症状及体征无特异性表现，早期诊断相当困难，往往需要术中才能确诊，误诊率高达90％～95％。现将我院2000年1月-2005年6月收治的16例SMVT患者的观察及护理报道如下。     

肠系膜上静脉血栓形成的诊治

目的探讨肠系膜上静脉血栓形成(MVT)的诊断及治疗。方法对收治的7例MVT临床资料进行回顾性分析。结果7例患者均手术证实，初诊全部为急腹症，症状与体征不相符，多数患者表现为肠梗阻的症状，有6例误诊，均经手术治疗；2例治愈，2例死亡，3例转院或自动出院。结论该病少见，临床对此病认识不足，症状与体征无特异性，难以作出正确诊断，误诊率高。充分认识本病，采用B超及CT检查，有助于对本病的早期诊断，早期切除坏死肠段及受累系膜、术后抗凝是降低死亡率、防止复发的关键。     

1例肝硬化消化道出血并发急性肠系膜静脉血栓的护理

正肝硬化合并上消化道出血临床较常见,伴发全腹疼痛亦时有发生,究其原因多为自发性腹膜炎、急性胰腺炎、肠穿孔、肠梗阻等引起,而由急性肠系膜上静脉血栓形成(superior mensenteric venous thrombosis,SMVT)引发者则较少见。由于SMVT早期症状不典型,极易误诊,且病情发展快、病死率高、预后差~[1-2],早期确诊、及时抗凝、溶栓治疗是提高预后的关键,可避免肠管进一步缺血坏死,并获得痊愈。因此,肝硬化门     

肠系膜静脉血栓形成31例临床分析

目的 分析肠系膜静脉血栓形成的临床特点,探讨其早期诊断和治疗方法.方法回顾性分析31例肠系膜静脉血栓形成患者的临床资料.结果31例患者中,急性组19例,36.8%患者有肢体血栓性静脉炎或肺栓塞史,均以腹痛为首发症状,并进行性加重,57.9%患者出现腹膜刺激征,68.4%出现腹水征;13例患者经腹部CT或选择性血管造影检查确诊,CT检出率83.3%;93.3%患者血浆D-二聚体升高;手术治疗13例,抗凝治疗6例,病死率15.8%,复发率21.1%,2例死亡.慢性组12例,均无急腹症表现,经腹部CT检查确诊,66.7%患者出现上消化道出血.结论肠系膜静脉血栓形成是一种缺乏特异性临床表现、病死率高的疾病,腹部CT检查对早期诊断有重要价值,及时手术、抗凝治疗可以降低病死率.     

Fogarty取栓管在肠系膜上静脉血栓手术中的应用11例分析

目的：探讨肠系膜上静脉血栓（SMVT）的诊治问题。方法：总结分析我院13a来应用Fogarty取栓管手术治疗的11例临床资料。结果：本组病例全部剖腹探查证实，均行小肠部分切除，最长达410cm，治愈10例（其中3例出现短肠综合征），1例术后死亡。结论：正确认识该病的临床表现，早期明确诊断，及时把握手术时机，应用Fogarty取栓管，术中术后常规抗凝治疗，可以进一步提高疗效。     

肠系膜静脉血栓形成10例分析

目的:探讨肠系膜静脉血栓形成的早期诊断及治疗原则,以减少并发症发生。方法:对10例肠系膜静脉血栓形成患者的临床特点、诊断及治疗方法进行分析。结果:全部手术治疗,均病理确诊为肠系膜静脉血栓形成。术前3例CT检查明确诊断,7例误诊。8例治愈,2例死亡。结论:对肠系膜静脉血栓形成应及早诊断及手术治疗,术后辅以抗凝治疗,可减少术后并发症和死亡的发生。     

肺动脉栓塞患者临床特征分析

目的探讨肺动脉栓塞的诊断与治疗方法。方法对24例肺动脉栓塞患者的基础疾病、临床症状、辅助检查及溶栓和抗凝治疗等资料进行回顾性分析,总结肺动脉栓塞患者有效的检查和治疗方法。结果肺动脉栓塞患者缺乏特异性临床表现,但临床症状和体征是疑诊的重要指征;心电图、超声心动图、血气分析,D-二聚体检测,螺旋CT均有助于肺动脉栓塞的早期确诊;早期溶栓及抗凝治疗可有效降低病死率。结论尽快确诊肺动脉栓塞,尽早采用溶栓和抗凝治疗,可提高患者的生存率、降低死亡率。     

急性肠系膜上静脉血栓形成的观察及护理16例

急性肠系膜静脉血栓(SMVT)是一种危重急腹症,病死率达32%[1],约占肠缺血疾病的15%～20%[2].因其临床症状及体征无特异性表现,早期诊断相当困难,往往需要术中才能确诊,误诊率高达90%～95%[1].现将我院2000年1月-2005年6月收治的16例SMVT患者的观察及护理报道如下.     

Anticoagulation management in the ambulatory surgical setting

Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.     

Recurrent primary mesenteric venous thrombosis

We have reported a case of recurrent primary mesenteric venous thrombosis resulting in small bowel infarction. Resection of necrotic bowel, anastomosis, and postoperative anticoagulation remain the cornerstone of management. Delay in diagnosis and treatment contributes to the high mortality. A history of peripheral thrombosis, antithrombin III deficiency, hypovolemia, or carcinoma in susceptible patients with abdominal pain should arouse suspicion of ischemic bowel.     

Locoregional anesthesia and anticoagulation

Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. Generally, a patient’s coagulation status should be optimized at the time of spinal or epidural needle/catheter placement, and the level of anticoagulation should be monitored during epidural catheterization. Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographic evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia.     

心脏机械瓣膜置换术后抗凝治疗中颅内出血的防护

回顾性总结我院14例心脏机械瓣膜置换术后抗凝治疗中,因抗凝强度不当导致颅内出血的病例。探讨术后抗凝治疗的防护。作者认为:术后抗凝治疗从开始治疗的第1日起即应监护至一生,这对减少抗凝治疗中出现的并发症,提高病人的生活质量,有重要的意义。     

Use of anticoagulation during wireless capsule endoscopy for the investigation of recurrent obscure gastrointestinal bleeding

Detecting the source of obscure gastrointestinal bleeding can be difficult. Capsule endoscopy is a promising diagnostic tool for investigating patients with this condition, although identifying the source of intermittent or low-grade bleeding remains a diagnostic challenge. We present case reports of two patients with obscure gastrointestinal bleeding, in whom the source of recurrent bleeding episodes was diagnosed by capsule endoscopy while they were on anticoagulation therapy. The first patient, an 81-year-old white woman, was on long-term oral anticoagulation because she had chronic atrial fibrillation. Capsule endoscopy demonstrated a bleeding tumor in the region of the terminal ileum. The second patient, a 59-year-old white man, underwent an initial capsule endoscopy, which was negative. After initiation of anticoagulation with heparin, a second capsule endoscopy procedure in this patient revealed several small bleeding lesions in the proximal small bowel. In both cases a gastrointestinal stromal tumor was identified as the bleeding source and was resected. These two cases demonstrate that provocation of bleeding during capsule endoscopy may increase its sensitivity.     

Anticoagulation in elective surgery.

Several categories of patients may be receiving anticoagulation therapy and require surgery. Many patients take cardioprotective aspirin or warfarin for atrial fibrillation, the presence of a mechanical heart valve, prior thromboembolism, a documented left ventricular thrombus, or a history of venous thromboembolism with or without a pulmonary embolism. Inpatients may be receiving injectable forms of anticoagulation to reduce risk of deep venous thrombosis or for other conditions, such as atrial fibrillation. Patients receiving any type of anticoagulation present a problem when they require surgery because the interruption of anticoagulant therapy increases their risk of thromboembolism and stroke (Schanbacher & Bennett, 2000). Rational decisions regarding the appropriateness of perioperative anticoagulation depend on individual patient factors and can only be made when the risk of perioperative thromboembolism is balanced against the risk of perioperative bleeding.     

Outpatient management of inflammatory bowel disease. Let's keep it as simple as possible.

Inflammatory bowel disease is a conglomeration of disorders of unclear etiology and pathogenesis. Confirming the diagnosis of active disease may be difficult but is critical to judicious therapy. Sulfasalazine (Azulfidine) and its newer derivatives mesalamine (Asacol, Rowasa) and olsalazine sodium (Dipentum) are used for treatment of mild disease and maintenance. Corticosteroid therapy controls moderate disease in most patients, but withdrawal may be difficult. Immunosuppression or surgery may be necessary in severe or refractory cases. The risk of cancer as a complication of inflammatory bowel disease is often exaggerated but cannot be ignored.     

Anticoagulation for venous thromboembolism. What are the current options?

Venous thromboembolism remains an important cause of considerable morbidity and mortality. Low-molecular-weight heparin appears to be a safe and effective alternative to unfractionated heparin for inpatient treatment. In addition, we recommend considering its use in outpatient treatment in selected patients. When warfarin therapy is initiated, the starting dose should approximate the suspected maintenance dose. The optimal length of anticoagulation after an initial episode of venous thromboembolism is 6 months unless a persistent risk factor is identified. Thrombolytic therapy for hemodynamically stable patients remains controversial, primarily because of the potential for devastating complications.     

Thromboembolism during pregnancy. Risks, challenges, and recommendations

Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. Physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. Diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism. Once the diagnosis is made, anticoagulation with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin should be used prepartum followed by warfarin therapy after delivery.     

Pulmonary embolism

PE, a common and serious pulmonary problem, most often results as a complication of DVT in the lower extremities. There are no specific symptoms or signs that allow a clinical diagnosis of PE. The best approach to the diagnosis is controversial and is at least partially dependent on the diagnostic capabilities and expertise available at a given hospital. Pulmonary arteriography is the definitive diagnostic test and should be considered in patients with results of less-than-high probability V-Q scans, those at high risk of bleeding complications with anticoagulation therapy, and those considered candidates for thrombolytic therapy.