| Objectives:Due to the blood flow in superior mesenteric artery(SMA)was interrupted,superior mesenteric artery embolism(SMAE)can make the blood-supply intestinal ischemia and lead to a series of clinical emergencies mainly characterized by severe abdominal pain.SMAE is clinically rare and little public awareness.Moreover,the clinical characteristics and laboratory of SMAE lack specificity,it is difficult to be diagnosed.SMAE is onset acute and progress fast,it can progress to intestinal necrosis in a short time.A large number of misdiagnosis and missed diagnosis increase the difficulty of treatment of SMAE and make adverse effect on prognosis.In order to evaluate the clinical characteristics of SAME,the clinical data was analysed in 42 SAME patients in a tertiary hospital from September 2015 to November 2020.Meanwhile,the risk factors of occurrence and prognosis of SMAE were discussed by analyzing the general condition,previous history,clinical manifestations,auxiliary examination,treatment methods and results.Methods:42 patients who were diagnosed with SMAE in a tertiary hospital from September 2015 to November 2020 were collected as the SMAE group(study group)through the hospital electronic medical record system.6 of 42 cases were diagnosed by exploratory laparotomy,and 36 cases were diagnosed by computer comography cngiography(CTA).According to the treatment outcome of the SMAE group,they were divided into death group(n=10 cases)and improvement group(n=32 cases).There was no significant difference in treatment methods between the two groups.And 42 patients who were discharged from hospital during the same period and their first diagnosis was chronic gastritis were randomly selected as the control group.There were no significant differences in gender and age between SMAE group and control group.The hospitalization data of 84 patients were collected for statistical analysis(including:gender,age,previous history,mainly clinical characteristics,peripheral blood cells,serum biochemistry,blood lipid,coagulation function,hepatorenal function,abdomen ultrasound and CT,peripheral vascular ultrasound,treatment methods and results,length of stay,and so on).These data were analysed to summarize the clinical characteristics and the risk factors of occurrence and prognosis of SMAE.Results:1 The clinical characteristics of SMAE1.1 Based on gender and age,these were more men(27/42,64.3%)than women(15/42,35.7%)in SMAE group.The age of SMAE group was 41-88 years old and the average age was(65.8±13.7)years old.l case(2.4%)of SMAE group was younger than 44 years old,15 cases(35.7%)from45 to 59,11 cases(26.2%)from 60 to 75,and 15 cases(35.7%)over the age of 75.It showed that the incidence of SMAE increased with age.There were 6 male patients(60.0%)and 4 female patients(40.0%)in death group.The age of death group was 60-88 years old and the average age was(74.5±9.8)years old.Most of the death cases were over the age of 60.And there were 21 male patients(65.6%)and 11 female patients(34.4%)in the improvement group.The age of improvement group was 41-87 years old and the average age was(62.8±13.7)years old.The average age of death group was older than improvement group(P<0.05).There was no significant difference in gender between the death group and improvement group.1.2 Based on the previous history,42 patients in SMAE group had history of hypertension in 22(52.4%),arteriosclerosis in 16/39(41.0%),atrial fibrillation in 17(40.5%),embolism in 14(33.3%),diabetes in 9(21.4%),and abdominal operation in 8(19.0%).The number of patients with heart disease in death group was significantly more than that in improvement group(P<0.05).1.3 Based on the clinical symptoms,all patients of SMAE group had acute abdominal pain.Severe abdominal symptoms with slight signs is one of the characteristics.The number of patients with nausea,vomiting,gastrointestinal bleeding and peritoneal irritation in the death group was more than that in the improvement group.1.4 Based on the laboratory inspection,the neutrophil percentage was elevated in 32 cases(76.2%)of SMAE group,white blood cells was elevated in 27 cases(64.3%),c-reaction protein was elevated in 29 cases(69.0%),prothrombin time was prolonged in 32 cases(76.2%),activated partial thromboplastin time was prolonged in 17 cases(40.5%),fibrinogen was elevated in 22 cases(52.4%)and D-dimer was elevated in 23 cases(54.8%).The level of blood urea nitrogen in death group was higher than that in improvement group(P<0.05),and platelets was lower than that in improvement group(P<0.05).The other indexes in death group were higher than those in improvement group,but the differences were not statistically significant.1.5 Based on the imaging examination,36 patients of SMAE group were diagnosed by computed tomography angiography(CTA),and all of them were found filling-defect of superior mesenteric artery(36/36,100%).In death group,there were more cases with multiple vascular embolism(embolism position≥2)than that in improvement group(60.0%vs 18.7%)(P<0.05).1.6 Based on the treatment,there were 25 cases(59.5%)inSMAE group were treated with thrombolytics alone and 7 cases(28.0%)died,12 cases(28.6%)with exploratory laparotomy and 2 cases died,5 cases(11.9%)with endovascular interventional and 1 case(20.0%)died.The mortality of patients who were treated with thrombolytics alone was the highest.2 The risk factors of SMAE2.1 The risk factors of occurrence of SMAE The single factor analysis showed that the age,hypertension,atrial fibrillation,arteriosclerosis,history of embolism,D-dimer and fibrinogen were positively correlated with the occurrence of SMAE(P<0.05,respectively).The multiple factors analysis showed that the atrial fibrillation,arteriosclerosis,history of embolism,history of abdominal surgery and fibrinogen were positively correlated with the occurrence of SMAE(P<0.05,respectively).2.2 The risk factors of prognosis of SMAE The single factor analysis showed that the age,heart disease and multiple vascular embolism were positively correlated with SMAE patients death(P<0.05).And the platelet was negatively correlated with SMAE patients death(P<0.05).Multiple factors analysis showed that the platelet was negatively correlated with SMAE patients death(P<0.05),and the multiple vascular embolism might be positively correlated with SMAE patients death(0.05<P<0.1).Conclusions:1.The main patients of SMAE are middle-aged and elderly people.The incidence of SMAE is increased with age.There are more men than women in SMAE group.In this study,mortality of SMAE is 23.8%,and gender has nothing to do with mortality.The age of the death group is mainly over 60 years old,and it is older than that of the improvement group.2.SMAE has no characteristic clinical manifestation and laboratory inspection.Severe abdominal symptoms with slight signs is one of the characteristics.Inflammation index elevates and coagulation function disorders are the most significant of early laboratory tests.Abdominal CTA is the best way to diagnose SMAE.Intravascular thrombolysis or thrombectomy and exploratory laparotomy are the most effective treatment methods.The cases of SMAE who have heart disease,reduced more platelets and/or with multiple vascular embolism would have a poorer prognosis.3.The presence of atrial fibrillation,arteriosclerosis,history of embolism,history of abdominal surgery and elevated fibrinogen are the risk factors of SMAE.Hrombocytopenia is the risk factor for death in patients with SMAE. |
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