急性肠系膜缺血:当代观点

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摘要

在2019冠状病毒病大流行期间,急性肠系膜缺血(AMI)的发病率上升至每10万人10.9例。在这里我们讨论AMI的病因、症状、目前的诊断和治疗。这类患者常伴有肠系膜上动脉狭窄或闭塞,并伴有冠状动脉疾病、慢性心力衰竭或慢性脑缺血。主要临床症状为持续性腹痛,肠系膜动脉血栓形成时腹痛尖锐,血栓局限于肠系膜上静脉或下静脉分支时腹痛沉闷。传统上,AMI的诊断是通过多层计算机断层血管造影和增强多层计算机断层扫描来验证的。及时诊断并进行紧急手术可将死亡率从90%降低到30-50%。早期血运重建和微创血管内介入治疗效果最好。
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Acute mesenterial ischaemia: a contemporary view
During the COVID-19 pandemic, the incidence of acute mesenteric ischemia (AMI) increased to 10.9 per 100 000 population. Here we discuss causes, symptoms, current diagnosis and treatment of AMI.Frequently, such patients suffer from stenosis or occlusion of superior mesenteric artery accompanied by coronary artery disease, chronic heart failure, or chronic brain ischaemia. The main clinical symptom is constant abdominal pain which is sharp in case of mesenteric artery thrombosis or dull if thrombosis is restricted to the branch of superior or inferior mesenteric veins. Conventionally, the diagnosis of AMI is verified by multislice computed tomography angiography and contrast-enhanced multislice computed tomography. Timely diagnosis with emergency surgery reduces mortality from 90% to 30-50%. The best treatment outcomes are observed after early revascularizations and minimally invasive endovascular interventions.
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