影响肠系膜上动脉栓塞取栓术预后的相关因素分析

目的总结急性肠系膜上动脉栓塞取栓术后影响其预后的因素并行分析。方法回顾性分析重症监护室1999～2008年收治17例肠系膜上动脉栓塞患者。患者按照腹膜刺激征阳性和阴性分为A组和B组。所有患者术前均由CTA三维重建和动脉造影确诊。手术采用肠系膜上动脉切开取栓或肠切肠吻合术。术后转入外科监护室,予抗凝、全胃肠外营养。肾功能不全及脓毒血症者接受血液滤过治疗。结果术后死亡10例,病死率58.8%,A组病死8例,B组死亡2例。A组病死率、术后外科监护室住院时间、升压药物应用时间、机械通气时间、血液滤过时间均高于B组（P〈0.05）。结论早诊断、早治疗,合理的手术方式及术后处理与肠系膜上动脉取栓术预后密切相关。

The analysis of the influence on the prognosis of embolectomy on the mesenteric arterial embolism

Objective To generalize the factors of the influence on the prognosis of embolectomy on the mesenteric arterial embolism.MethodsSeventeen cases of superior mesenteric arterial（SMA） embolism were analyzed retrospectively.The patients were divided into group A and group B respectively depending on the peritoneal irradiative sign（Group A： Positive;Group B： Negative）.All the cases was confirmed by CTA three-dimension reconstruction and arteriography prior to surgery.The embolectomy of SMA with or without enterectomy was performed on these patients.All cases were transferred to surgical intensive care unit and given anticoagulation as well as parenteral nutrition post operation.The patients with renal failure or sepsis underwent hemofiltration therapy.ResultsTen cases was dead post operation with 58.8% death rate.Eight patients died in Group A while only two in Group B.The Mortality,the duration of ICU,the time for adminstration of pressor agent,the time of mechanical ventilation as well as the time of dialysis in Group A all was statistically higher than those in Group B（P〈0.05）.ConclusionThe early diagnosis and treatment,the appropriate surgical method as well as postoperative intervention relate closely to the prognosis of patients underwent embolectomy on the mesenteric arterial embolism.