{"type5":[],"type4":[],"type3":[{"id":"5951","isDel":0,"createAt":1508142864571,"createBy":"8abb11d0af1511e7a3d800163e04584d","createName":"良药苦口","updateAt":1522055562095,"updateBy":"8abb11d0af1511e7a3d800163e04584d","updateName":"良药苦口","userId":"8abb11d0af1511e7a3d800163e04584d","title":"解析--肠系膜血管缺血性疾病治疗","content":"


早期诊断、早期及时治疗肠系膜血管缺血性疾病十分关键。一经确诊，须尽早手术，患者预后与之密切相关。若患者已有大量肠坏死，则预后极差，死亡率很高；如能侥幸存活，也常伴有短肠综合征，生活质量很差。

\"解析--肠系膜血管缺血性疾病治疗\"

对于急性肠系膜上动脉栓塞，医生可行动脉取栓术。术者在检查缺血肠管活性后若发现已有肠坏死，应行坏死肠管切除术。若急性肠系膜上动脉血栓形成，可行选择性导管溶栓或手术治疗，如腹主动脉-肠系膜上动脉、髂动脉或脾动脉-肠系膜上动脉或回结肠动脉血管旁路转流术等。如有肠坏死，也应行坏死肠管切除术。

 

主动脉夹层累及肠系膜上动脉者，如出现肠缺血坏死，医生在处理主动脉夹层后，应立即行肠系膜上动脉血运重建、坏死肠管切除术。对于孤立性肠系膜上动脉夹层，如出现肠缺血坏死或夹层动脉瘤破裂，须即刻开腹手术。其余患者可接受保守治疗，若经治后腹痛不缓解、或经CTA证实夹层范围进展者，可行血管腔内介入治疗。对于解剖条件不适合或血管腔内治疗失败者，可通过手术重建肠系膜上动脉。

 

急性肠系膜上静脉血栓形成、早期未出现肠坏死者，应接受肝素抗凝治疗，也可接受尿激酶溶栓，随后口服华法林抗凝，抗凝过程中监测凝血功能。一旦疑有肠坏死，医生应及时行手术探查，施行坏死肠管切除术，切除范围应包括全部有静脉血栓形成的肠系膜，否则术后静脉血栓有继续发展的可能；术后继续行抗凝治疗。在肠切除时，是否应行静脉切开取栓尚有争议。静脉切开取栓治疗仅对少数门静脉及肠系膜静脉主干发生的血栓有效；而肠系膜静脉血栓大多发生于肠系膜静脉分支内，取栓治疗常无效，也难以成功。

 

有心房颤动病史的肠系膜上动脉栓塞患者极有可能再发动脉栓塞，甚至危及生命。医生须尽量去除心源性或血管源性栓子来源、严密监视患的生命体征、维护重要脏器功能、积极抗感染、纠正水电解质紊乱及酸中毒。

 

找良医网温馨提示：如有身体不适，请及时就医！

","barId":"2469","topicTypeId":"2","topicThemeId":"1032","readLevel":1,"files":"[]","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1245,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1508142864573,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1508142864573,"metaSearch":null,"rn":null}],"type2":[{"id":"8528","isDel":0,"createAt":1512094910199,"createBy":"db869ccaaef711e7a3d800163e04584d","createName":"海绵宝宝","updateAt":0,"updateBy":null,"updateName":null,"userId":"db869ccaaef711e7a3d800163e04584d","title":"血栓性疾病出现时的症状是什么","content":"

\"血栓性疾病出现时的症状是什么\"

 

（一）静脉血栓形成以下肢深静脉血栓形成最为多见：

 

常见于深静脉如腘静脉、股静脉、肠系膜静脉及门静脉等。多为红细胞血栓或纤维蛋白血栓。主要表现有：

 

1、血栓形成的局部肿胀、疼痛；

 

2、血栓远端血液回流障碍：如远端水肿、胀痛、皮肤颜色改变、腹水等；

 

3、血栓脱落后栓塞血管引起相关脏器功能障碍，如肺梗死的症状、体征等。

 

（二）动脉血栓形成多见于冠状动脉、脑动脉、肠系膜动脉及肢体动脉等，血栓类型早期多为血小板血栓，随后为纤维蛋白血栓。临床表现有：

 

1、发病多较突然，可有局部剧烈疼痛，如心绞痛、腹痛、肢体剧烈疼痛等；

 

2、相关供血部位组织缺血、缺氧所致的器官、组织结构及功能异常，如心肌梗死、心力衰竭、心源、性休克、心律失常、意识障碍及偏瘫等；

 

3、血栓脱落引起脑栓塞、肾栓塞、脾栓塞等相关症状及体征；

 

4、供血组织缺血性坏死引发的临床表现，如发热等。

 

（三）毛细血管血栓形成常见于DIC、TTP及溶血尿毒症综合征（HUS）等：

 

临床表现往往缺乏特异性，主要为皮肤粘膜栓塞性坏死、微循环衰竭及器官功能障碍。


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肠系膜血管缺血性疾病是由各种原因引起肠道急性或慢性血流灌注不足、回流受阻所致的肠壁缺血坏死和肠管运动功能障碍的一种综合征。凡全身血液循环动力异常、肠系膜血管病变以及其他全身或局部疾病引起的肠壁缺血，均可引发本病。此病可累及全消化道，但以左半结肠较为常见，尤以结肠脾曲多见。这是由于结肠脾曲是由肠系膜上、下动脉末梢吻合部供血，对抗缺血的能力最弱，易于发生供血不足。这类疾病已不少见，其中以发生于肠系膜动脉，特别肠系膜上动脉者多于肠系膜静脉。因肠系膜血管急性血循环障碍而导致肠管缺血坏死，临床上表现为血运性肠梗阻。临床可分为急性肠系膜缺血、慢性肠系膜缺血及结肠缺血。

\"什么是肠系膜血管缺血性疾病\"

一、病因

 

1.肠系膜上动脉栓塞

肠系膜上动脉栓塞可使肠系膜上动脉血供突然减少或消失，导致肠壁肌肉功能障碍，肠急性缺血、坏死，是小肠血运障碍性肠梗阻中最常见的一种。临床上肠系膜上动脉栓塞是一种少见的疾病，但其一旦发生，病情极其凶险，病死率极高。肠系膜上动脉栓塞，栓子多来自心脏，如心肌梗死后的壁栓，心瓣膜病，心房纤颤，心内膜炎等；也可来自主动脉壁上粥样斑块。栓塞可发生在肠系膜上动脉出口处，更多见于远侧较窄处，常见部位在中结肠动脉出口以下。

 

2.肠系膜上动脉血栓形成

肠系膜上动脉血栓形成，大多在动脉硬化性阻塞或狭窄的基础上发生，常涉及整个肠系膜上动脉，也有较局限者。肠系膜上动脉栓塞的栓子主要来源于心脏，如心肌梗死后的壁栓，亚急性细菌性心内膜炎的瓣膜赘生物，风湿性心脏瓣膜病变处的赘生物，左心耳、左心房附壁血栓的脱落以及人工瓣膜置换术后形成的血栓脱落等；也有来源于大动脉粥样硬化的附壁血栓，粥样斑块的脱落和脓肿，脓毒血症的细菌栓子等。

 

3.肠系膜上静脉血栓形成

肠系膜上静脉血栓形成，可继发于腹腔感染、肝硬化门静脉高压致血流淤滞、真性红细胞增多症、高凝状态和外伤或手术造成血管损伤等。

肠系膜上静脉血栓形成可分为原发性和继发性两种。病因明确者称为继发性，病因不明者称为原发性或特发性。随着对遗传性凝血功能障碍诊断以及高凝状态识别能力的增强，特发性病例在本病所占的比例在逐渐缩小，目前大部分的肠系膜静脉血栓形成可以获得病因诊断。最为常见的原因是遗传性或获得性疾病所导致的高凝状态，如肿瘤、腹腔炎症、手术后、肝硬化及门静脉高压。年轻女性肠系膜上静脉栓塞患者中有部分使用口服避孕药。

 

找良医网温馨提示：如有身体不适，请及时就医！

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肠系膜血管缺血性疾病治疗中应该注意哪些？如果您患了肠系膜血管缺血性疾病应及早诊断，及早治疗，包括支持疗法和手术治疗。肠系膜上动脉栓塞可行取栓术。血栓形成则可行血栓内膜切除或肠系膜上动脉-腹主动脉“搭桥”手术。如果已有肠坏死，应作肠切除术。肠系膜上静脉血栓形成需施行肠切除术，切除范围应包括全部有静脉血栓形成的肠系膜，否则手术后静脉直栓有继续发展的可能。手术后并应继续行抗凝治疗。急性肠系膜血管缺血性疾病，临床常因认识不到位而误诊，如果不幸一旦发生广泛的肠梗塞坏死，预后凶险，死亡率很高。


\"肠系膜血管缺血性疾病治疗中应该注意哪些

 

找良医网温馨提示：治疗期间一定要听医生叮嘱，少吃辛辣食物，戒烟戒酒。上述就是找良医网专家给您的建议，如果您对上述内容已经了解的话，请您继续关注我们的网站，每天都会有新的更新。最后找良医网祝您身体健康！



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肠系膜血管缺血性疾病是由各种原因引起，多发生于老年人。其形成是在严重动脉硬化性闭塞的基础上逐渐发生的，故起病隐匿。因长期慢性肠系膜动脉缺血导致侧支循环的建立，所以肠系膜血管缺血性疾病是由哪些原因引起的？


\"看专家向您回答肠系膜血管缺血性疾病是由哪些原因引起的

 

A、肠系膜上动脉栓塞，栓子多来自心脏，如心肌梗塞后的壁栓，心瓣膜病、心房纤颤、心内膜炎等．也可来自主动脉壁上粥样斑块；栓塞可发生在肠系膜上动脉出口处，更多见于远侧较窄处，常见部位在中结肠动脉出口以下。

 

B、肠系膜上动脉血栓形成，大部分在动脉硬化性阻塞或狭窄的基础上发生，常涉及整个肠系膜上动脉．也有较局限者。

 

C、肠系膜上静脉血栓形成，可并发于腹腔感染、肝硬化门静脉高压致血流淤滞、真性红细胞增多症、高凝状态和外伤或手术造成血管损伤等。

 

以上几个观点就是专家告诉您的肠系膜血管缺血性疾病是由哪些原因引起的，那么通过上述的介绍，相信您也有所了解了吧，那么如果您还有其他想了解的话，请你继续关注我们的网站，后期每天都会有新的内容更新，祝您早日康复！

 


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\"肠系膜上动脉血栓形成发病的原因\"


（一）发病原因

 

肠系膜上动脉血栓形成多发生在动脉粥样硬化的基础上，这类病人常合并弥漫性动脉硬化，如冠状动脉硬化，严重外周动脉疾病和腹主动脉与髂动脉粥样硬化疾病等。此外，肠系膜血管移植术后，血管创伤、血液凝固状态的改变亦可促使血栓形成。

 

（二）发病机制

 

动脉粥样硬化发生于肠系膜上动脉的起始部，病程逐渐发展，血管逐渐狭窄变细，血流缓慢，血栓形成。由于病程缓起，肠系膜上动脉、腹腔动脉、肠系膜下动脉在这个过程中，可形成侧支循环，避免了肠管的即刻坏死。但在维持消化功能需要更多的血液供应的过程中会出现肠缺血的症状。在血栓形成后，肠坏死即可发生。特点是肠坏死的范围广泛，自十二指肠至左半结肠均可累及，病死率高。


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\"为什么会出现血栓性疾病\"

 

血栓性疾病的病因本病的病因及发病机制十分复杂，迄今尚未完全明确，但近年的研究表明血栓性疾病的发生、发展主要与以下因素有关：

 

1、血管内皮损伤当血管内皮细胞因机械（如动脉粥样硬化）、化学（如药物）、生物（如内毒素）、免疫及血管自身病变等因素受损伤时，可促使血栓形成。

 

2、血小板数量增加，活性增强各种导致血小板数量增加、活性增强的因素，均有诱发、促进血栓性疾病发生的可能性，如血小板增多症、机械、化学、生物及免疫反应等导致的血小板破坏加速等。

 

3、血液凝固性增高在多种生理及病理状态下，人体凝血活性可显著增强，表现为某些凝血因子水平升高或活性增加，如妊娠、高龄及创伤感染等所致的应激反应、高脂血症、恶性肿瘤等。而高凝状态是血栓性疾病的发病基础。

 

4、抗凝活性减低人体生理性抗凝活性减低，是血栓形成的重要条件。

 

5、血液流变学异常各种原因引起的血液粘滞度增高、红细胞变形能力下降等，均可导致全身或局部血流淤滞、缓慢，为血栓形成创造条件。如高纤维蛋白原血症、高脂血症、脱水、红细胞增多症等。


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肠系膜血管缺血性疾病是由各种原因引起肠道急性或慢性血流灌注不足、回流受阻所致的肠壁缺血坏死和肠管运动功能障碍的一种综合征。凡全身血液循环动力异常、肠系膜血管病变以及其他全身或局部疾病引起的肠壁缺血，均可引发本病。此病可累及全消化道，但以左半结肠较为常见，尤以结肠脾曲多见。这是由于结肠脾曲是由肠系膜上、下动脉末梢吻合部供血，对抗缺血的能力最弱，易于发生供血不足。这类疾病已不少见，其中以发生于肠系膜动脉，特别肠系膜上动脉者多于肠系膜静脉。因肠系膜血管急性血循环障碍而导致肠管缺血坏死，临床上表现为血运性肠梗阻。临床可分为急性肠系膜缺血、慢性肠系膜缺血及结肠缺血。那么接下来一起来了解下肠系膜血管缺血性疾病的病因有哪些？


\"肠系膜血管缺血性疾病的病因\"


1.肠系膜上动脉栓塞

肠系膜上动脉栓塞可使肠系膜上动脉血供突然减少或消失，导致肠壁肌肉功能障碍，肠急性缺血、坏死，是小肠血运障碍性肠梗阻中最常见的一种。临床上肠系膜上动脉栓塞是一种少见的疾病，但其一旦发生，病情极其凶险，病死率极高。肠系膜上动脉栓塞，栓子多来自心脏，如心肌梗死后的壁栓，心瓣膜病，心房纤颤，心内膜炎等；也可来自主动脉壁上粥样斑块。栓塞可发生在肠系膜上动脉出口处，更多见于远侧较窄处，常见部位在中结肠动脉出口以下。

 

2.肠系膜上动脉血栓形成

肠系膜上动脉血栓形成，大多在动脉硬化性阻塞或狭窄的基础上发生，常涉及整个肠系膜上动脉，也有较局限者。肠系膜上动脉栓塞的栓子主要来源于心脏，如心肌梗死后的壁栓，亚急性细菌性心内膜炎的瓣膜赘生物，风湿性心脏瓣膜病变处的赘生物，左心耳、左心房附壁血栓的脱落以及人工瓣膜置换术后形成的血栓脱落等；也有来源于大动脉粥样硬化的附壁血栓，粥样斑块的脱落和脓肿，脓毒血症的细菌栓子等。

 

3.肠系膜上静脉血栓形成

肠系膜上静脉血栓形成，可继发于腹腔感染、肝硬化门静脉高压致血流淤滞、真性红细胞增多症、高凝状态和外伤或手术造成血管损伤等。

 

肠系膜上静脉血栓形成可分为原发性和继发性两种。病因明确者称为继发性，病因不明者称为原发性或特发性。随着对遗传性凝血功能障碍诊断以及高凝状态识别能力的增强，特发性病例在本病所占的比例在逐渐缩小，目前大部分的肠系膜静脉血栓形成可以获得病因诊断。最为常见的原因是遗传性或获得性疾病所导致的高凝状态，如肿瘤、腹腔炎症、手术后、肝硬化及门静脉高压。年轻女性肠系膜上静脉栓塞患者中有部分使用口服避孕药。


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