A型主动脉夹层合并肠系膜上动脉缺血的研究进展

doi:10.3969/j.issn.1004-583X.2025.07.013

摘要/Abstract

摘要：

肠系膜上动脉缺血是A型主动脉夹层罕见且致命的并发症,严重影响患者的近远期预后。近年来,随着医疗与护理领域的持续革新与优化,A型主动脉夹层合并肠系膜上动脉缺血的诊疗与护理实践取得了显著进展。本文对A型主动脉夹层合并肠系膜上动脉缺血的流行病学、影像学检查、血清生物学指标、治疗策略及围术期重症监护室的精准生命监测与支持进行系列阐述,以期为疾病早期诊断、治疗及临床管理奠定基础。

关键词: 动脉瘤, 夹层, 肠系膜缺血, 诊断, 治疗, 研究进展

中图分类号:

毛静静, 兰云霞, 陈鲁玉, 宋先荣. A型主动脉夹层合并肠系膜上动脉缺血的研究进展[J]. 临床荟萃, 2025, 40(7): 659-662.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: http://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.07.013

http://www.lchc.cn/CN/Y2025/V40/I7/659

参考文献 41

[1]	Malaisrie SC, Szeto WY, Halas M, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection[J]. J Thorac Cardiovasc Surg, 2021, 162(3): 735-758. doi: 10.1016/j.jtcvs.2021.04.053 pmid: 34112502
[2]	Charlton-Ouw KM, Sandhu HK, Leake SS, et al. Need for limb revascularization in patients with acute aortic dissection is associated with mesenteric ischemia[J]. Ann Vasc Surg, 2016, 36: 112-120. doi: S0890-5096(16)30474-5 pmid: 27423717
[3]	Velayudhan BV, Idhrees AM, Mukesh K, et al. Mesenteric malperfusion in acute aortic dissection: Challenges and frontiers[J]. Semin Thorac Cardiovasc Surg, 2019, 31(4): 668-673. doi: S1043-0679(18)30376-9 pmid: 30980930
[4]	Yagdi T, Atay Y, Engin C, et al. Impact of organ malperfusion on mortality and morbidity in acute type A aortic dissections[J]. J Card Surg, 2006, 21(4): 363-369. doi: 10.1111/j.1540-8191.2006.00246.x pmid: 16846414
[5]	Eusanio MD, Trimarchi S, Patel HJ, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: Observations from the international registry of acute aortic dissection[J]. J Thorac Cardiovasc Surg, 2013, 145(2): 385-390. doi: 10.1016/j.jtcvs.2012.01.042 pmid: 22341418
[6]	Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection:A 20-year experience of collaborative clinical research[J]. Circulation, 2018, 137(17): 1846-1860. doi: 10.1161/CIRCULATIONAHA.117.031264 pmid: 29685932
[7]	王宝珠, 李燕, 马翔, 等. 急性主动脉夹层早期CTA诊断价值研究[J]. 中国数字医学, 2019, 14(10):2-4.
[8]	金红旭, 赵晓东, 吕传柱, 等. 2020中国急性肠系膜缺血诊断与治疗专家共识[J]. 中国急救医学, 2020, 40(9):804-812.
[9]	JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): Digest version[J]. Circ J, 2013, 77(3):789-828. pmid: 23412710
[10]	凯赛尔江·卡地尔, 艾克力亚尔·艾尼瓦尔, 马翔. 人工智能在主动脉夹层影像学诊断与风险预测中的应用[J]. 中华心血管病杂志, 2021, 49(11):1152-1156.
[11]	Song L, Zhang X, Zhang J, et al. Deep learning-assisted diagnosis of acute mesenteric ischemia based on CT angiography images[J]. Front Med, 2025, 12(5): 23-26.
[12]	Blaser AR, Starkopf J, Björck M, et al. Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: A systematic review and meta-analysis[J]. World J Emerg Surg, 2023, 18(1): 44. doi: 10.1186/s13017-023-00512-9 pmid: 37658356
[13]	Nuzzo A, Guedj K, Curac S, et al. Accuracy of citrulline, I-FABP and D-lactate in the diagnosis of acute mesenteric ischemia[J]. Sci Rep, 2021, 11(1): 1-10.
[14]	Destek S, Yabacı A, Abik YN, et al. Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia[J]. Ulus Travma Acil Cerrahi Derg, 2020, 26(1):86-94. doi: 10.14744/tjtes.2019.61580 pmid: 31942740
[15]	Peoćh K, Nuzzo A, Guedj K, et al. Diagnosis biomarkers in acute intestinal ischemic injury: So close, yet so far[J]. Clin Chem Lab Med, 2018, 56(3): 373-385. doi: 10.1515/cclm-2017-0291 pmid: 28841570
[16]	Matsumoto S, Sekine K, Funaoka H, et al. Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia[J]. Br J Surg, 2014, 101(3): 232-238. doi: 10.1002/bjs.9331 pmid: 24402763
[17]	Zenger S, Piroglu ID, Çevik A, et al. The importance of serum intestinal fatty acid-binding protein for the early diagnosis of acute mesenteric ischemia[J]. Ulus Travma Acil Cerrahi Derg, 2021, 27(3):278-283. doi: 10.14744/tjtes.2020.35823 pmid: 33884597
[18]	Zhuang X, Chen F, Zhou Q, et al. A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia: A retrospective study[J]. BMC Gastroenterol, 2021, 21(1): 154. doi: 10.1186/s12876-021-01746-0 pmid: 33827660
[19]	Sinz S, Schneider MA, Graber S, et al. Prognostic factors in patients with acute mesenteric ischemia-novel tools for determining patient outcomes[J]. Surg Endosc, 2022, 36(11): 8607-8618. doi: 10.1007/s00464-022-09673-1 pmid: 36217056
[20]	Nuzzo A, Maggiori L, Ronot M, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: Prospective study from an intestinal stroke center[J]. Am J Gastroenterol, 2017, 112(4): 597-605. doi: 10.1038/ajg.2017.38 pmid: 28266590
[21]	Kusadokoro S, Kimura N, Miyoshi K, et al. Early superior mesenteric artery revascularization for acute type A aortic dissection with cardiac tamponade and mesenteric malperfusion[J]. J Card Surg, 2020, 35(12): 3581-3584.
[22]	Hirahara H, Sugawara M, Naitou T, et al. Stanford type A acute aortic dissection with leg ischemia and visceral ischemia[J]. Kyobu Geka, 2022, 75(6):411-415.
[23]	Geana RC, Pavel P, Nayyerani R, et al. Successfully superior mesenteric artery stenting in operated type A aortic dissection complicated with delayed mesenteric malperfusion[J]. SAGE Open Med Case Rep, 2021, 9(2): 1-6.
[24]	Sugiyama K, Watanuki H, Okada M, et al. Revascularization-first strategy in acute aortic dissection with mesenteric malperfusion[J]. J Card Surg, 2020, 35(11): 3004-3009.
[25]	Mukherjee D, Collins DT, Ryan L. Retrograde stenting of the superior mesenteric artery is the procedure of choice for dissection of the aorta with mesenteric compromise[J]. J Vasc Surg Cases Innov Tech, 2019, 5 (4): 431-434. doi: 10.1016/j.jvscit.2019.06.014 pmid: 31660466
[26]	邹凌威, 刘轶凡, 刘浩, 等. 主动脉夹层合并难治性肠系膜上动脉缺血的手术治疗策略及疗效分析[J]. 中华外科杂志, 2024, 62(3):235-241.
[27]	Huang LC, Chen SK, Peng H, et al. A visceral organ function-focused therapeutic strategy using a 6-hour time window for patients with acute type A aortic dissection complicated by mesenteric malperfusion[J]. J Cardiothorac Surg, 2024, 19(1):183.
[28]	温珍银, 王凤珍, 黄宇炀, 等. 急性主动脉夹层病人围术期血压管理的最佳证据总结[J]. 全科护理, 2024, 22(22):4159-4164.
[29]	Bai L, Ge L, Zhang Y, et al. Experience of the postoperative intensive care treatment of stanford type A aortic dissection[J]. Int J Clin Pract, 2023, 2023: 1-6.
[30]	孙海燕, 秦少华, 赵堂海, 等. 38例急性肠系膜上动脉缺血腔内介入治疗的围手术期护理[J]. 临床普外科电子杂志, 2021, 9(3):52-56.
[31]	Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 146(24): e334-e482.
[32]	张艳娟, 田青, 庞冉, 等. 主动脉夹层患者术前疼痛管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(10):914-920.
[33]	Morello F, Santoro M, Fargion AT, et al. Diagnosis and management of acute aortic syndromes in the emergency department[J]. Intern Emerg Med, 2021, 16(1): 171-181.
[34]	Blaser AR, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines[J]. Intensive Care Med, 2017, 43(3): 380-398. doi: 10.1007/s00134-016-4665-0 pmid: 28168570
[35]	余云, 王哲芸, 王岩, 等. A型主动脉夹层术后并发急性肠系膜上动脉缺血患者的护理[J]. 护理学杂志, 2022, 37(20):51-53.
[36]	王玉伟, 李慧, 李银玲, 等. 7例Stanford A型主动脉夹层合并肠系膜上动脉缺血患者的术后护理[J]. 中华护理杂志, 2022, 57 (4): 476-480. doi: 10.3761/j.issn.0254-1769.2022.04.014
[37]	吴庆华, 韩延民, 杨宝钟, 等. 急性肠系膜上动脉栓塞小肠广泛坏死七例治疗经验[J]. 中华普通外科杂志, 2001, 16(12):725-727.
[38]	Fuglsang S, Heiberg J, Hjortdal VE, et al. Exercise-based cardiac rehabilitation in surgically treated type-a aortic dissection patients[J]. Scand Cardiovasc J, 2017, 51(2):99-105. doi: 10.1080/14017431.2016.1257149 pmid: 27808563
[39]	Chaddha A, Kline-Rogers E, Braverman AC, et al. Survivors of aortic dissection: Activity, mental health, and sexual function[J]. Clin Cardiol, 2015, 38(11): 652-659. doi: 10.1002/clc.22418 pmid: 26769699
[40]	段海燕, 兰云霞. 基于ERAS理念的多学科协作对Stanford A型主动脉夹层患者Ⅰ期心脏康复的应用效果研究[J]. 临床研究, 2024, 32(2):171-174.
[41]	Llerena J, Velasteguí S, Kumar A. Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection[J]. J Card Surg, 2022, 37(6):1803.

A型主动脉夹层合并肠系膜上动脉缺血的研究进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 41

相关文章 15

编辑推荐

Metrics

本文评价

[1]	卢远思, 吕见君, 官计彬, 操龙斌. 双相情感障碍患者外周血中FGF1的表达与糖脂代谢的相关性[J]. 临床荟萃, 2025, 40(7): 619-623.
[2]	孙振晓, 于相芬. 皮肤搔抓障碍的研究进展[J]. 临床荟萃, 2025, 40(7): 647-652.
[3]	林彬城, 林刚曦. 病因、术前病程对药物难治性癫痫患儿疗效的影响[J]. 临床荟萃, 2025, 40(6): 527-531.
[4]	王思晗, 李向红, 李亮亮, 锡洪敏, 杨萍, 马丽丽, 尹向云. 新生儿RYR1相关肌病1例并文献复习[J]. 临床荟萃, 2025, 40(6): 541-546.
[5]	潘凌峰, 林芳芳, 杨川. 人工智能在前列腺癌超声诊断中的应用[J]. 临床荟萃, 2025, 40(6): 547-552.
[6]	孙振晓, 于相芬. 幻肢痛的临床治疗进展[J]. 临床荟萃, 2025, 40(6): 570-576.
[7]	刘萍, 于猛, 刘明新, 李文锋. 血常规衍生的新型炎症指标与急性前壁ST段抬高型心肌梗死患者PCI术后院内发生不良心血管事件的相关性[J]. 临床荟萃, 2025, 40(5): 400-407.
[8]	赵雅静, 陶千山, 沈元元, 董毅. 地西他滨维持治疗对适合强化疗中低危急性髓细胞白血病患者生存的影响[J]. 临床荟萃, 2025, 40(5): 439-444.
[9]	范玉雯, 宋佳, 黄盼娜, 张晓岚. 淋巴细胞归巢在炎症性肠病中的作用及相关治疗靶点[J]. 临床荟萃, 2025, 40(5): 468-472.
[10]	赵世亮, 牛艳国, 赵燕民, 李俊青, 洪丽, 王献. 颅内动脉瘤介入术后认知功能障碍的因素探讨:基于PSM法[J]. 临床荟萃, 2025, 40(4): 320-324.
[11]	苏淼, 王飒爽, 赵东强. 《中国肥胖症消化内镜治疗专家共识》解读[J]. 临床荟萃, 2025, 40(4): 366-371.
[12]	蒲武涛, 肖宜欣, 妥丽, 凯丽比努尔·马木提, 范雪婷, 崇乐. 超声造影诊断肝包虫病的系统评价和meta分析[J]. 临床荟萃, 2025, 40(3): 197-204.
[13]	黄兴舟, 郑卫华, 张树桐, 陈燕浩. 载药微球与常规支气管动脉化疗栓塞术治疗晚期非小细胞肺癌的临床疗效及安全性对比[J]. 临床荟萃, 2025, 40(3): 243-250.
[14]	李忠标, 赵习浩, 杜敏, 王江, 于跃, 张佃良. 肠腔内生性卵巢外腹膜浆液性乳头状腺癌1例并文献复习[J]. 临床荟萃, 2025, 40(3): 257-261.
[15]	季万里, 马周, 石郁喜, 孙为生. 青年脊髓硬脊膜动静脉瘘1例并文献复习[J]. 临床荟萃, 2025, 40(3): 262-265.