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血清乳酸测定与CT结合判断胃肠道气肿预后
美国阿拉巴马大学医学院的Hawn MT博士指出，CT诊断的肠道气肿包括从良性疾病到肠缺血的多种疾病，因此，结合其它手段判断PI患者预后、指导治疗至关重要。
研究人员对CT发现的PI病例进行回顾研究，共68名患者CT诊断PI，其中结肠、小肠和胃的发生率各为51%、36%和9%。50%的患者采用手术治疗，总的死亡率为42%，手术死亡率47%。
单变量分析表明血清乳酸>2.0mmol/L与死亡率显著相关，年龄体现出一定相关性，但未达显著性水平。多变量分析表明血清乳酸>2.0mmol/L是住院期间死亡的唯一预后因素。
Hawn博士认为，CT诊断小肠气肿（PI）的患者，如血清乳酸大于2.0mmol/L，其死亡率高达80%。此时需请外科会诊，决定是否需要急诊手术。
Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract.
Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, Vickers SM.
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0016, USA.
Computed tomography (CT) diagnosis of pneumatosis involving the gastrointestinal tract can represent a broad range of clinical entities from a benign process to ischemic bowel. The purpose of this study is to define the significance and outcome of pneumatosis intestinalis (PI). All CT scans from 5/93 to 12/01 with the finding of PI were reviewed. Eighty-six CT scans had the finding of PI, with the colon being the most frequent location (51%), followed by small bowel (36%) and gastric (9%). Forty per cent of patients underwent surgery, with an overall mortality rate of 42 per cent and a surgical mortality rate of 47 per cent. Univariate analysis demonstrated significant correlation between serum lactic acid (LA) > 2.0 mmol/L [odds ratio (OR) = 23.4; 95% confidence interval (C.I.), 7.21-75.92] and serum creatinine > 1.5 mg/dL (OR = 3.05; 95% C.I., 1.25-7.42) with mortality. Age was suggestive but not a significant risk factor for mortality (P = 0.09). Multivariate analysis found serum LA > 2.0 (OR = 30.37; 95% C.I., 7.31-126.2) to be the only significant predictor of mortality. CT diagnosis of PI is associated with significant in-hospital mortality, especially in the elderly. Serum LA level > 2.0 mmol/L at time of diagnosis is associated with a greater than 80 per cent mortality. Surgical consultation is necessary to determine which patients need urgent surgical intervention.
Am Surg. 2004 Jan;70(1):19-23 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-25 17:43
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