| Objectives:To investigate the method of early diagnosis and the effect of different treatment program on the cure rate of acute superior mesenteric artery embolism (AMAE) patients.Methods:49 patients were recruited from 01/01/2011-12/31/2015 in Shandong provincial Qianfoshan hospital affiliated to Shandong University. All patients were definitive diagnosed by clinical and lab examination, for example computer tomography angiography (CTA) or digital subtraction angiography (DSA). Clinical data were collected including age, gender, clinical manifestations, attack time, past history, white blood cell (WBC) D-dimer and so on. Patients were divided into three groups which were the conservative treatment group, exploratory laparotomy group and CDT group (including CDT treatment and conversion to laparotomy treatment) according different treatments. Results were divided into the cure group and the death group. The cure group:followed up one year after discharge during which good daily life, no abdominal pain, bloating, and discomfort after eating, indicators were regular reviewed and no significant abnormality. The death group:including died during hospitalization and died after discharge from infection and organ failure, in patients with short bowel syndrome after abandoning treatment. All the above data was analyzed by the SPSS19.0 statistical software.Results:1. Characteristics:there were 30 males,19 female (1.58:1), aged 45-81, median age 65 years, mean (64.37±9.31), average time of onset (3.05±3.28) days, mainly over 60 years old which was 71.43％(35/49). There were 6 patients in conservative treatment group included 2 males and 4 females,2 patients were cured. There were 15 patients in exploratory laparotomy group,10 males and 5 females, and 6 patients were cured. There were 28 patients in CDT group (including CDT treatment and conversion to laparotomy treatment), and 16 patients were accepted CDT treatment included 9 males and 7 females,12 patients were cured.12 patients were accepted the conversion to laparotomy,9 males and 3 females, and 8 patients were cured.25 patients were hospitalized within 24h after onset whose mean D-dimer were (4.83± 2.62) mg/L and mean WBC were (15.21±4.82) ×109/L, and 7 patients were dead, so the mortality is 28.00%.24 patients were hospitalized after 24h whose mean D-dimer were (5.01±3.03) mg/L, and mean WBC were (17.24±4.71) ×109/L, and 14 patients were dead, so the mortality is 58.33%. There was no statistical significance between the onset time and D-dimer or WBC. There was statistical significance (P﹤0.05) between the onset time and patient cure rate (P<0.05).2. Analysis of high risk factors:37 patients suffered from atrial fibrillation and the mortality rat is 75.51％.20 patients suffered from hypertension and the mortality rat is 40.82%.16 patients suffered from coronary heart disease, and the mortality rat is 32.65％.12 patients suffered from cerebral infarction, and the mortality rat is 24.49％. Only 2 patients (4.08％) did not have heart disease history.Conclusion:1. Early diagnosis and treatment is the key to improve the cure rate of AMAE. For patients with acute dramatic abdominal pain, variance of signs and clinical symptoms, painkiller drug ineffectiveness, gastrointestinal emptying symptoms, such as, dramatic of vomiting and diarrhea, and patients with atrial fibrillation or peripheral artery embolism history should be wary. Run CTA or DSA test if necessary. Abdominocentesis with bloody liquid has important clinical meaning.2. CDT treatment is feasible in patients with no intestinal necrosis and mild clinical symptoms. Close observation is necessary during the treatment, and make preparation for laparotomy. Laparotomy should be taken in patients with peritonitis. SMA embolectomy may revitalize partially necrotic bowel in early stage, thus reduce the length of bowel resection and the incidence of short bowel syndrome.3. Combined diseases such as atrial fibrillation and coronary heart disease should be aggressive treated meanwhile the AMAE therapy to reduce the risk of recurrence of the disease. |
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