Nnukwu Ischemia mesenteric, mgbakasị afọ, na ihe mberede mgbụsị akwụkwọ na mberede¶

Nnukwu mesenteric ischemia (AMI) bụ ihe mberede mberede vaskụla na afọ ịwa ahụ nke ọbara na-esi na nnukwu akwara ma ọ bụ veins na-enye obere eriri afọ na nnukwu eriri afọ (nke na-abụkarị ** akwara mesenteric artery [SMA]) na-ebipụ na mberede site na mkpụkọ ọbara akwara ( embolism) ma ọ bụ mkpụkọ ọbara ọgbụgba. mesenteric ischemia**), ma ọ bụ venous mkpụkọ (** mesenteric venous thrombosis**). Dị nnọọ ka akwara ụbụrụ egbochiri na-akpata ọrịa strok na akwara ụkwụ egbochiri na-akpata nnukwu ischemia, akwara eriri afọ egbochiri na-akpata " ọrịa strok intestinal / nkụchi obi nke eriri afọ" nke eriri afọ dị nro (mucosa) nke obere eriri afọ na-amalite ịnwụ n'ime nkeji iri atọ ruo 60. (** transmural bowel infarction ***) n'ime awa 6 ruo 12 ***. Ọ bụrụ na onye toro eto (karịsịa onye ọ bụla nwere fibrillation atrial, nkụchi obi na nso nso a, nkụchi obi, ma ọ bụ ọrịa vaskụla) na-etolite na mberede, ihe mgbu na-egbu mgbu nke etiti afọ na-esonyere vomiting ma ọ bụ afọ ọsịsa ngwa ngwa, kpọọ mpaghara gị. nọmba mberede ozugbo. Mgbe ị na-echere ndị na-ahụ maka ahụike, nyochaa ntuziaka mberede vaskụla na afọ ime metụtara aortic dissection na mgbawa abdominal aortic aneurysm, mgbochi afọ, hernia strangulated, na volvulus, na nnukwu ọrịa pancreatitis na gallbladder.

N'ihi na ọrịa eriri afọ na-adịghị agwọ ọrịa na-ebu ọnụ ọgụgụ ọnwụ nke pasent 60 ruo 80 , nlanarị na-adabere n'inweta ihe mberede ahụ n'oge windo mmalite mmalite ya (awa 6 mbụ) site n'ịghọta otu njirimara ụlọ ọgwụ a ma ama: ** na-egbu mgbu afọ 10/10 nke na-enweghị oke na nyocha ahụ dị nro, nke a na-apụghị ịgbagha agbagha.

Mee nke a ugbu a¶

1. Kpọọ nọmba mberede mpaghara gị ozugbo wee rịọ ka ebuga gị n'ụlọ ọgwụ nwere ikike ịwa ahụ nke Vascular na General. Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia, ma ọ bụ lelee ndepụta anyị nọmba mberede. Kwupụta n'ụzọ doro anya: " A na-enyo enyo nnukwu mesenteric ischemia / gut blood clot: mgbu afọ na-egbu mgbu na mberede na-adabere na nyocha nke onye ọrịa nwere fibrillation (ma ọ bụ ọrịa obi / obi)."
2. ** Ghọta "Ọnyà afọ dị nro" (Mgbu n'ogo nke nyocha anụ ahụ)** N'ime awa 1 ruo 6 nke mbụ mgbe mkpụkọ ọbara na-egbochi akwara mesenteric dị elu, onye ọrịa ahụ na-ewe iwe ma na-asụ ude na 10/10 mgbu afọ etiti, ma mgbe gị ma ọ bụ onye na-ahụ maka ahụike na-eji nwayọọ na-agbanye n'afọ ha, ** afọ na-adị jụụ ma ọ bụrụ na ọ na-eme ka ahụ dị nro kpamkpam. ịdị nro**. Ya adịla mgbe ị na-eche na ihe mgbu bụ "naanị gas, mgbaze, ma ọ bụ nje afọ" n'ihi na afọ na-adị nro; Mgbe afọ na-aghọ nkume siri ike na nke siri ike, eriri afọ ahụ anwụọla ma gbarie.
3. ** Debe onye ọrịa ahụ nke ọma site n'ọnụ (NPO: mmiri efu, nri efu, ọgwụ antacids efu, ọgwụ mgbu efu). Nke mbụ, ịgbari nri ma ọ bụ mmiri mmiri na-amanye eriri afọ oxygen na-agụsi ike ịrụsi ọrụ ike ma chọọ ka ikuku oxygen dịkwuo elu, na-eme ka ọnwụ mucosal dịkwuo elu. Nke abụọ, onye ọrịa chọrọ ihe mberede mberede ozugbo CT Angiography (CTA) na-esote catheter thrombectomy ma ọ bụ laparotomy ime ụlọ n'okpuru mgbakasị izugbe.
4. ** Debe onye ọrịa ahụ ka ọ dinara larịị ma ọ bụ nọrọ n'ọnọdụ izu ike dị mma (ikpere gbadatụrụ ntakịrị) wee mee ka ọ kpoo ọkụ.
5. ** Kpesa akụkọ ọ bụla gbasara Atrial Fibrillation (karịsịa doses nke ọbara na-efu efu), nkụchi obi na-adịbeghị anya, ma ọ bụ "egwu nri" (ihe mgbu postprandial na-adịghị ala ala) nye ndị na-ahụ maka ahụike ozugbo.* warfarin. Gwa ndị na-ahụ maka ahụike aha kpọmkwem na oge ọgwụ ikpeazụ nke mkpụrụ obi niile na ọgwụ ndị na-ebelata ọbara.
6. Adịla etinye ihe mkpuchi ọkụ n'afọ ma ọ bụ nye ọgwụ laxatives ma ọ bụ enemas. Okpomọkụ dị n'èzí na-ebuli agụụ oxygen nke mgbidi eriri afọ nke ischemic, ebe laxatives ma ọ bụ enemas na-akpali peristalsis n'ike ma nwee ike imebi eriri afọ ischemic ma ọ bụ obere eriri afọ.

Osisi mkpebi: mgbu afọ siri ike na mberede na nnukwu mesenteric ischemia triage¶

flowchart TD
    Start["Mgbu mgbu Central Central / Periumbilical na mberede na onye ọrịa nwere fibrillation atrial, nkụchi obi na-adịbeghị anya, nkụda mmụọ obi, PAD, ma ọ bụ ọrịa mgbochi"] --> ClassicTriad{"Kwụpụ 1: Lelee Triad Embolic Classic: Ihe mgbu na-egbu mgbu 10/10 KWURU ka ọ bụrụ ule afọ dị nro, imefusị ike ike (vomiting/afọ ọsịsa), ma ọ bụ AFIb / tupu egwu nri?"}

    ClassicTriad -->|"EE ka ọ na-egbu mgbu na-enweghị oke ma ọ bụ atọ"| Emergency["ISCHEMIA enyo enyo enyo enyo enyo MESENTERIC (window nchekwa awa 6): Kpọọ Ọrụ Mberede (911 / 112 / 999) ozugbo."]

    ClassicTriad -->|"Enweela bọọdụ siri ike dị ka afọ, stool ọbara gbara ọchịchịrị, mgbagwoju anya, iku ume ngwa ngwa, ma ọ bụ ọbara mgbali elu."| Infarction["MKPỤRỤ NDỊ NA-ECHICHE NA PERITONITIS: Ọgba aghara ịwa ahụ na-eyi ndụ egwu; Kpọọ 911 ozugbo"]

    Emergency --> Prehospital["1. Enyemaka mbụ nke ụlọ ọgwụ: NPO siri ike (enweghị mmiri, nri, antacids, ma ọ bụ ọgwụ ọnụ), dina ala n'ọnọdụ dị mma, na-ekpo ọkụ, ma kọọ AFib ma ọ bụ oghere ọbara."]
    Infarction --> Prehospital

    Prehospital --> HospitalCTA["2. Nchọpụta Ụlọ Ọgwụ ozugbo & Ntugharị Ntugharị: STAT Biphasic CT Angiography (CTA) nke Abdomen / Pelvis na-echeghị lactate, IV crystalloids, IV Heparin drip, na Broad-spectrum IV ọgwụ nje."]

    HospitalCTA --> Revasc["3. Hybrid OR Endovascular & Surgical Bowel Salvage: Endovascular Aspiration Thrombectomy / Stenting or Surgical Embolectomy, megharịa bowel necrotic n'ezoghị ọnụ, na atụmatụ Laparotomy nke Abụọ n'ime awa 24 ruo 48."]

Anatomi na pathophysiology: ihe kpatara na nnukwu akwara Mesenteric (SMA) bụ "bulseye" maka mkpụkọ obi.¶

Ogwe akwara atọ a na-ejikọtaghị ọnụ na-apụ n'ihu nke aorta abdominal iji nye akụkụ eriri afọ mmadụ dum:

1. ** Osisi Celiac:** Na-enye afo, imeju, gallbladder, splin, pancreas, na duodenum elu (embrayo ** foregut**).
2. ** The Superior Mesenteric Artery (SMA):** na-enye ** obere eriri afọ* ( duodenum dị ala, jejunum na ileum) gbakwunyere ** ọkara aka nri nke nnukwu eriri afọ ** (cecum, colon na-arị elu, na ụzọ abụọ n'ụzọ atọ nke eriri afọ transverse, embrayo ** midgut**).
3. ** Ọkụ akwara nke dị ala (IMA):** na-enye eriri afọ na-agbada, sigmoid colon, na ikensi elu (ẹmbrayo hindgut).

Kedu ihe kpatara 85% nke visceral arterial clots ji nọrọ n'ime akwara Mesenteric Elu¶

Mgbe mkpụkọ ọbara na-esi n'obi pụta (dịka ọmụmaatụ, site na aka ekpe atrial appendage n'oge atrial fibrillation ma ọ bụ na mgbidi ventricular aka ekpe mgbe ọ gbasịrị obi mgbawa) ma gbadaa aorta abdominal, ọ fọrọ nke nta ka ọ bụrụ mgbe niile na-efega ozugbo na ** Super Mesenteric artery (SMA)** karịa ogwe celiac ma ọ bụ na-arịa ọrịa ụbụrụ. Gịnị kpatara? - Ogwe Celiac dị na aorta dị nkọ, ihe fọrọ nke nta ka ọ bụrụ ** 90-degree perpendicular angle **, na akwara mesenteric dị ala dị warara na caliber. - N'ụzọ dị iche, ** Elu Mesenteric Artery ** nwere ọnụ obosara na alaka dị n'ihu aorta na akụkụ dị nro, na-agbadata ** 45-degree oblique angle *, ọ fọrọ nke nta ka ọ dakọtara na isi iyi aortic. Mkpụkọ ọbara na-agbada n'ime aorta na-eso ụzọ nke obere nkwụsi ike gbadaa n'ogo 45-ogo n'ime SMA, na-anọkarị ** 3 ruo 8 centimeters gafere mmalite dịpụrụ adịpụ nke akwara colic etiti.

Ihe mere afọ na-adị nro mgbe onye ọrịa na-eti mkpu na nhụjuanya (Visceral vs. Somatic Pain)¶

Ịghọta ihe na-enye akwara afọ abụọ nke afọ na-akọwa otu ihe ngosi nlekọta ahụike kachasị mkpa na ọgwụ mberede, ** "ihe mgbu na-erughị nyocha anụ ahụ"**:

1. ** Awa 0 ruo 6 (Mucosal Ischemia na Ahụhụ Visceral Na-ahụ Maka Ahụhụ - OGE BELLY dị nro):**
2. Ihe mkpuchi nke ime n'ime eriri afọ (* mucosa na submucosa , nke ọtụtụ nde villi na-eri nri na-edozi ahụ) na-eri ** pasent 70 nke mkpokọta ọbara na-erugharị nke mgbidi eriri afọ ma bụrụ anụ ahụ kachasị arụ ọrụ n'ime afọ.
3. N'ime ** 15 ruo 30 nkeji ** nke mgbochi SMA, mucosal villi na-amalite ịta ahụhụ ma na-apụ apụ, ebe akpụkpọ anụ ahụ dị nro nke mgbidi eriri afọ na-abanye n'ime ihe ike, tetanic ** ischemic spasm ** (na-eme ka onye ọrịa na-agbapụta ike ma nyefee afọ ọsịsa iji wepụ eriri afọ).
4. Ọrịa ischemic a na-eme ka mgbaàmà mgbu dị ukwuu site na ** autonomic visceral C-fibers *** na-aga n'akụkụ irighiri akwara mesenteric gaa n'ọkpụkpụ azụ (T8-T11), na-eme ka mgbu na-egbu mgbu, na-adịghị ala ala, na etiti afọ mgbu.
5. ** Otú ọ dị, elu elu nke eriri afọ (serosa) ka dị ndụ , ya mere, ọ naghị eme ka ọkpụkpụ mgbidi dị n'èzí na-egbuke egbuke ( parietal peritoneum **). Ya mere, mgbe dọkịta ma ọ bụ onye na-ahụ maka ahụike na-agbanye n'èzí afọ onye ọrịa, akwara afọ nke afọ adịghị echekwa ma ọ bụ na-atụgharị ma ọlị: ** onye ọrịa nọ na nhụjuanya 10/10, ma afọ na-adị nro kpamkpam.
6. ** Oge awa 6 ruo 12+ (Transmural Necrosis na Somatic Peritonitis - ỌGBỤGHỊ BELLY RIGID):**
7. Mgbe awa 6 ruo 12 gachara ọbara efu, ọnwụ cellular na-ere ọkụ n'ụzọ niile site na mgbidi muscular ruo n'èzí ** serosal elu ** nke eriri afọ (** transmural infarction / gangrene **).
8. Bacteria, endotoxin, na mmiri necrotic na-esi na mgbidi eriri afọ nwụrụ anwụ wee metụ **parietal peritoneum ** nke dị n'ime mgbidi afọ, nke ejiri eriri somatic siri ike jikọọ ya.
9. Naanị ugbu a afọ na-atụgharị ** bọọdụ siri ike, siri ike, na nke dị nro na ntakịrị mmetụ ma ọ bụ kpụ ọkụ n'ọnụ nke onye na-agbatị (ntụgharị nro na peritonitis) **, na-esonyere ya na stool gbara ọchịchịrị na-esi ísì ọjọọ ("currant-jelly" stool), septic shock, na ọtụtụ akụkụ ahụ.

Ụdị ụlọ ọgwụ 4 dị iche iche nke nnukwu mesenteric ischemia¶

Dabere na **WSES na ntuziaka ESVS ***, nnukwu ischemia mesenteric na-akpata site na usoro anọ dị iche iche, nke ọ bụla nwere profaịlụ onye ọrịa nke ya, ọsọ mmalite na ọgwụgwọ ụlọ ọgwụ:

Ọdịiche dị ukwuu nke mesenteric ischemia sitere na ischemic colitis na ọgba aghara afọ ndị ọzọ¶

Abụọ dị iche iche nke gut ischemia dị, na mgbagwoju anya ha na-eduga na igbu oge dị ize ndụ: ** Acute Mesenteric Ischemia (AMI)** na-emetụta ** obere eriri afọ (SMA)* ma na-egbu ngwa ngwa na-enweghị ihe mberede revascularization, ebe ** Ischemic Colitis ** na-emetụta ** mmiri mmiri mpaghara nke nnukwu eriri afọ (colon) na-elekọta ụlọ ọgwụ na-enyekarị nlekọta na-adịghị mma.

Kedu ihe kpatara ọkwa lactate ọbara nkịtị anaghị ewepụ nnukwu ischemia mesenteric¶

Otu n'ime akụkọ ifo kacha egbu egbu n'ime ụlọ mberede na-echere ọbara dị elu ** serum lactate level (lactic acidosis)** tupu ịtụnye CT angiogram maka ischemia a na-enyo enyo.

Ọkọlọtọ ọla edo na-achọpụta ụlọ ọgwụ yana ịwa ahụ / endovascular salvage ngwakọ¶

Mgbe ị bịarutere na ngalaba mberede ma mee ka ndị otu ahụ mara maka ischemia a na-enyo enyo na-enyo enyo na ọ nwere nnukwu mesenteric ischemia, nkeji ọ bụla na-adabere na windo mgbapụta afọ 6 nke **:

1. Ngwa ngwa Biphasic Computed Tomography Angiography (CTA)¶

Ụzarị ụzarị afọ dị larịị na ultrasounds nke afọ ọsịsa enweghị ike iwepụ ischemia mesenteric (ka oge X-ray na-egosi afụ gas n'ime mgbidi eriri afọ, nke a na-akpọ ** pneumatosis intestinalis **, ma ọ bụ gas na vein portal, eriri afọ ahụ anwụọla). - Otu ule a ga-amanyere bụ **STAT Biphasic (Arterial + Portal Venous Phase) Multidetector CT Angiogram (CTA) nke Abdomen na pelvis ** nwere ọdịiche dị n'ime intravenous (na ** Ọ nweghị ọdịiche ọnụ **, nke na-egbu oge nyocha ahụ otu elekere wee kpuchie arịa ọbara eriri afọ). - Ọbụlagodi na onye ọrịa ahụ nwere creatinine dị elu ma ọ bụ ọrịa akụrụ na-adịghị ala ala, ntuziaka nyere iwu inye ọdịiche IV ozugbo **, n'ihi na nnukwu ischemia mesenteric na-efu efu fọrọ nke nta ka ọ bụrụ ihe na-egbu egbu n'ụwa niile, ebe enwere ike ijikwa ahụ ike nephropathy na hydration IV.

2. Mkpokọta resuscitation ahụike ozugbo¶

Tupu onye ọrịa abanye n'ime ụlọ ịwa ahụ ma ọ bụ ụlọ ntinye aka, ndị otu mberede na-amalite usoro ọgwụgwọ anọ ozugbo: 1. ** Mweghachi Crystalloid Intravenous: ** Isotonic fluid (Ringer's lactate or normal saline) iji weghachi olu intravascular furu efu n'ime mgbidi eriri afọ fụrụ akpụ. 2. ** Heparin Bolus na-adịghị emebi emebi nke eriri afọ ozugbo na ntapu:** na-egbochi mkpụkọ ahụ na SMA ma ọ bụ SMV ịgbasa n'ime obere alaka ụlọ egwuregwu. 3. ** Broad-Spectrum Intravenous Antibiotics:** N'ihi na mucosal villi na-amalite ịnwụ n'ime nkeji iri atọ, nje bacteria (* E. coli , Klebsiella, Bacteroides) na-atụgharị ozugbo gafee ihe mgbochi eriri afọ mebiri emebi n'ime ọbara; ntuziaka nyere iwu ọgwụ nje IV ozugbo na-ekpuchi Gram-negative bacilli na anaerobes (dịka ọmụmaatụ, ** ceftriaxone ma ọ bụ cefepime + metronidazole, ma ọ bụ ** piperacillin-tazobactam*). 4. ** Izere Alfa-Adrenergic Vasoconstrictors: ** Ọ bụrụ na ọbara mgbali na-adị ala mgbe mmiri gasịrị, ndị dọkịta na-anwa izere norepinephrine dị elu ma ọ bụ vasopressin (nke na-amachi akwara gut akwara) ma na-ahọrọ inotropes dị ka dobutamine ma ọ bụ obere dose vasopressor nkwado ozugbo olu-mejupụtara.

3. Revascularization, Mmebi-Control Resection, na "Second-Lek Laparotomy"¶

N'ime ụlọ ọrụ ** ngwakọ ọgbara ọhụrụ *, ndị dọkịta na-awa ahụ vaskụla na izugbe na-arụ ọrụ n'akụkụ: 1. Nke mbụ: * Mgbe ọ bụla eriri afọ ọ bụla nwere ike ịzọpụta, a na-eweghachi ọbara na-ebu ụzọ site na ** endovascular catheter aspiration thrombectomy, mechanical thrombectomy, ma ọ bụ SMA stenting , ma ọ bụ site na ** mepere emepe Fogarty balloon embolectomy / aorto-mesenteric bypass. Ọtụtụ loops nke chi jiri, eriri afọ na-acha anụnụ anụnụ na-atụgharị pink na-egbuke egbuke wee malite nkwekọrịta ọzọ n'ime nkeji iri na ise nke iweghachite akwara akwara. 2. ** Weghachite afọ n'eziokwu nwụrụ anwụ (oji/ gbawara agbawa) NA-AKWAGHỊ ịdụkọta ọnụ ọnụ azụ azụ (n'ịwa ahụ na-emebi emebi): Akụkụ eriri afọ ọ bụla nke dịlarị oji, mpempe akwụkwọ, ma ọ bụ nke gbawara agbawa ka a na-eji ịwa ahụ kwụchie wee wepụ ya. 3. ** Ihe dị mkpa nke 24-to-48-Hour "Laparotomy nke abụọ-Lee": ** N'ihi na ọ naghị ekwe omume n'oge mbụ ịwa ahụ iji gwa ma oke oke-dusky loops nke obere eriri afọ ga-agbake mgbe ọbara na-alaghachi ma ọ bụ nwee ọganihu na necrosis, ndị dọkịta na-awa ụma na-ahapụ eriri afọ stapled na-ejedebe n'ime afọ n'okpuru ihe mgbakwasa na-adịru nwa oge (ABCUta) na onye ọrịa ahụ. ** 24 ruo 48 awa ***, wee kpọghachi onye ọrịa ahụ n'ọnụ ụlọ ịwa ahụ maka ** Laparotomy nke Abụọ ** iji nyochaa centimita ọ bụla nke eriri afọ fọdụrụ tupu ịkwa eriri afọ ahụ dị mma akwụsị ọnụ. Usoro a na-echekwa centimita dị oke mkpa nke obere eriri afọ ma na-egbochi ndụ ogologo ndụ ** Ọrịa afọ dị mkpụmkpụ **.

Ndepụta mgbochi: ịmata "Intestinal Angina" na ichebe mgbochi AFib¶

• Ọ bụrụ na onye toro eto nwere akụkọ ihe mere eme nke ise siga, ọrịa akwara dị n'akụkụ, ma ọ bụ ọrịa obi na-amalite imegharị ahụ mgbu afọ na-adịghị ala ala ** 15 ruo 60 nkeji mgbe ị richara nri ** (na-adịgide adịgide 1 ruo 2 awa ruo mgbe mgbaze gwụ), na-amalite na-eri nri na obere ihe mgbu. na-atụfu ibu n'amaghị ama, rịọ maka ntụnye ịwa ahụ vaskụla ngwa ngwa maka ultrasound duplex mesenteric ma ọ bụ CTA. Ịmepụta mmalite SMA dị warara nke ọma na-egbochi ọrịa infarction thrombotic na-egbu egbu.
• ** Nọgidesie ike nke ọma na ndị na-eme ka ọbara na-edozi ahụ na Atrial Fibrillation:** kwụsịtụ ma ọ bụ kwụsị apixaban, rivaroxaban, edoxaban, dabigatran, ma ọ bụ warfarin na-enwetaghị ntuziaka dọkịta doro anya.
• ** Nọgidenụ na-agba mmiri nke ọma n'oge ebili mmiri ọkụ ma ọ bụ ọrịa afọ ** ma ọ bụrụ na ị nwere ọrịa vaskụla siri ike ma ọ bụ akụkọ ihe mere eme nke mkpụkọ ọbara venous.

Ozi iji kpokọta maka ụlọ ọgwụ vaskụla na otu ịwa ahụ¶

Mgbe ị na-eche ụgbọ ihe mberede, ịkwadebe akụkụ anọ nke akụkọ ihe mere eme ahụike na-echekwa nkeji dị egwu na ngalaba mberede:

1. ** Oge elekere kpọmkwem ihe mgbu afọ na-amalite: ** Dị ka nlekọta ọrịa strok ma ọ bụ nkụchi obi, ndị dọkịta na-awa vaskụla na-eji kpọmkwem elekere mmalite nke mgbaàmà iji chọpụta otú eriri afọ si dị nso na 6-hour transmural necrosis threshold.
2. ** Ndepụta zuru oke nke ụda obi na nchọpụta vaskụla:** Dee ma onye ọrịa nwere paroxysmal ma ọ bụ na-adịgide adịgide atrial fibrillation, valvụ obi prosthetic, infarction myocardial na nso nso a, mpụta akwara na-agafe, ma ọ bụ akụkọ ihe mere eme nke thrombosis miri emi ma ọ bụ pulmonary embolism.
3. ** Mgbanwe ọgwụ na-adịbeghị anya ma ọ bụ usoro ọgwụgwọ furu efu:** Weta karama ndenye ọgwụ niile, na-eleba anya n'ụzọ pụrụ iche na ihe nrịbama ọbara ọ bụla emere na nso nso a maka nleta eze, colonoscopy, ma ọ bụ ịwa ahụ, ma ọ bụ diuretic (ọgwụ mmiri) ma ọ bụ digoxin ọ bụla malitere ọhụrụ.
4. ** Ọrụ akụrụ tupu oge ma ọ bụ akụkọ ihe mere eme nke nrịanrịa dị iche:** Ikwe ka onye dibịa mberede mara ọrụ akụrụngwa ntọala nke onye ọrịa na-enyere ha aka ịkwadebe hydration intravenous post-scan ka ha na-aga ozugbo na biphasic CT angiogram na-azọpụta ndụ.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

Nnukwu ischemia mesenteric chọrọ ibuga ụgbọ ihe mberede ozugbo gaa nnukwu ụlọ ọgwụ nwere ** 24-hour CT Angiography, Vascular Surgery, Interventional Radiology, na General/ Trauma Surgery ***:

• United States na Canada: Kpọọ 911. Rịọ mbugharị gaa na ụlọ ọgwụ dị elu ma ọ bụ ụlọ ọgwụ Ọkwa ½ (agala ụlọ ọgwụ na-ahụ maka ngwa ngwa maka nnukwu mgbu afọ na mberede).
• United Kingdom: Kpọọ 999 maka ụgbọ ihe mberede mberede ma ọ bụ gaa ozugbo na nnukwu nnukwu ụlọ ọgwụ Ngalaba Mberede (A&E) nwere ebe dị na Arterial Vascular Center na ịwa ahụ mberede mberede.
• European Union: Kpọọ 112. Ejiri ya n'okpuru **European Society for Vascular Surgery (ESVS) Ntuziaka Omume Clinical na Nlekọta Ọrịa nke Arteries Meenteric na Veins *** na ** WSES Ntuziaka ***.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand.
• India na Asia-Pacific: Kpọọ 112 (ma ọ bụ 108 na India),995 na Singapore,119 na Japan na South Korea, ma ọ bụ 999 na Malaysia na Hong Kong. Gaba ozugbo na ụlọ ọgwụ dị elu nwere 24-hour MDCT angiography na vaskụla/GI ịwa ahụ.

Ajụjụ a na-ajụkarị¶

Kedu ihe "mgbu na-erughị ule anụ ahụ" pụtara na nnukwu ischemia mesenteric?¶

N'ọtụtụ ọnọdụ mberede nke afọ (dị ka appendicitis ma ọ bụ ọnyá na-agbawa agbawa), oghere dị n'èzí nke oghere afọ (parietal peritoneum) na-agba ọkụ ozugbo, ya mere ịpị n'ime afọ onye ọrịa na-akpata mgbu siri ike na ahụ ike siri ike (nchekwa). N'ime nnukwu ọrịa ischemia mesenteric, mkpụkọ ọbara na-ebu ụzọ buru ọnụ n'ime ime n'ime eriri afọ ebe elu dị n'èzí na-anọgide na-adịchaghị mma maka awa 4 ruo 6 mbụ. Nke a na-ebute ihe mgbu visceral dị omimi nke 10/10 nke na-eme ka onye ọrịa na-enwe nkụda mmụọ, ma mgbe dọkịta na-agbanye n'èzí afọ, afọ na-enwe mmetụta zuru oke na ahụ iru ala. Ịghọta ndakọrịta nke a n'ime awa 6 mbụ bụ ihe na-azọpụta ndụ onye ọrịa.

Kedu ihe kpatara ndị nwere fibrillation atrial ji nọrọ n'ihe ize ndụ dị elu maka mkpụkọ ọbara eriri afọ na mberede?¶

N'ime fibrillation atrial (AFib), ọnụ ụlọ dị elu nke obi na-ama jijiji n'oge na-adịghị anya kama ịmanye nke ọma, na-ekwe ka ọbara na-adaba adaba n'ime obere akpa a na-akpọ aka ekpe atrial appendage. Ọ bụrụ na onye ọrịa na-atụfu doses nke ọbara ha (ma ọ bụ nwere AFib a na-achọpụtaghị), otu n'ime mkpụkọ ahụ nwere ike ịgbaji, wepụ ya n'obi n'ime aorta, wee gbadaa n'ogo 45-ogo nke akwara mesenteric dị elu, na-ewepụ ọbara na-eruba n'ime eriri afọ niile n'otu obi.

Kedu ihe bụ "egwu nri" (sitophobia) ma ọ bụ "angina intestinal," gịnị kpatara o ji bụrụ akara ịdọ aka ná ntị?¶

Dị nnọọ ka akwara obi gbawara agbawa na-akpata mgbu obi (angina) n'oge mgbatị ahụ mgbe akwara obi chọrọ ọbara ka ukwuu, akwara eriri afọ nke cholesterol na-akpata na-akpata crampy Central abdominal mgbu 15 ruo 60 nkeji mgbe erichara nri, mgbe eriri afọ chọrọ ọbara ọzọ iji gbarie nri. N'ime izu ma ọ bụ ọnwa, ndị ọrịa na-amụta na iri nri na-akpata mgbu, n'ihi ya, ha na-atụ egwu iri nri (sitophobia) ma hapụ 10 ruo 30 pound n'amaghị ama. Ihe dị ka pasent 70 nke ndị ọrịa na-ata ahụhụ nnukwu akwara mesenteric thrombosis nwere mgbaàmà ịdọ aka ná ntị ndị a tupu oge eruo; ijide na steepụ akwara dị warara n'oge na-egbochi mgbata afọ.

Nnwale lactic acid (lactate) ọbara nkịtị nwere ike wepụ akwara eriri afọ egbochiri?¶

Mba, ọ dịghị mgbe. N'ime awa 2 ruo 6 mbụ nke nnukwu ischemia mesenteric mesenteric, lactic acid nke eriri afọ nke agụụ oxygen na-emepụta na-adaba n'ime veins nke eriri afọ ma ọ bụ kpochaa ya kpam kpam site na imeju tupu ya erute veins dị na ogwe aka ebe ọbara na-adọta. Ka ọ na-erule oge ọkwa lactate ọbara na-arịgo elu, mgbidi eriri afọ ahụ enweelarị gangrene na-enweghị ike ịgbanwe. Ndị dọkịta ga-enye iwu ka CT angiogram dị iche ozugbo dabere na enyo ụlọ ọgwụ na-echeghị ka lactate bilie.

Kedu ihe kpatara ndị dọkịta na-awa ahụ ji eme "Laparotomy nke abụọ" awa 24 ruo 48 mgbe ịwachara eriri afọ?¶

Mgbe ndị dọkịta na-awa ahụ na-eweghachi ọbara na-eruba n'ime eriri afọ ischemic ma wepụ akụkụ ọ bụla nke doro anya na oji na ndị nwụrụ anwụ, ogologo ogologo nke eriri afọ nke fọdụrụ na-ele anya na-acha ọkụ ma na-agbaji, na-eme ka ọ ghara ikwe omume ịmara nke ọma n'ime awa mbụ ma loops ndị ahụ ga-agbake ma ọ bụ nwụọ. Ọ bụrụ na ndị dọkịta na-awa ahụ na-ebipụ eriri afọ niile dị n'ókè ozugbo, onye ọrịa nwere ike hapụ ya na Short Bowel Syndrome (enweghị ike ịmịnye nri). Kama nke ahụ, ndị dọkịta na-awa ahụ na-ahapụ afọ n'ime uwe nwa oge, kwado onye ọrịa na ICU maka awa 24 ruo 48 iji mee ka eriri afọ ahụ gbakee, wee nyochaa eriri afọ ahụ n'ime ụlọ ịwa ahụ tupu ịmaliteghachi njedebe ahụike.

Kedu ihe dị iche n'etiti nnukwu mesenteric ischemia na ischemic colitis?¶

Nnukwu ischemia mesenteric bụ ihe na-eyi ndụ egwu mgbochi nke akwara akwara (oke akwara mesenteric) na-enye obere eriri afọ na eriri afọ aka nri; ọ na-akpata 10/10 mgbu etiti ma na-egbu 60 ruo 80 pasent nke ndị ọrịa ọ gwụla ma a na-eweghachi ọbara ọgbụgba n'ime awa ole na ole. Ischemic colitis bụ ihe a na-ahụkarị, nke na-adịkarị nwa oge na-adaba na ọbara microvascular gaa na "mmiri" agbagọ nke eriri afọ aka ekpe (colon), na-eme ka afọ ntachi dị n'akụkụ aka ekpe na-esote n'ime awa 24 site na maroon ma ọ bụ ọbara ọbara na-egbuke egbuke na stool; Ihe karịrị pasenti 80 nke ọrịa ischemic colitis na-agwọ n'ime ụbọchị ole na ole site na mmiri intravenous na izu ike nke afọ.

Isi mmalite na nduzi ọchịchị¶

• ** World Society of Emergency Surgery (WSES, International): *** Nnukwu Mesenteric Ischemia: Ntuziaka emelitere nke World Society of Emergency Surgery * (Bala et al., * World Journal of Surgery Surgery *, 2022/2023 update: CTA ozugbo na-echeghị lactate, mgbochi ọrịa obi, ọgwụ mgbochi vaskụla na-emebi emebi, vaskụla na-emebi emebi na-emebi emebi, na-emebi vaskụla vaskụla. laparotomy nke abụọ).
• ** European Society for Vascular Surgery (ESVS, Europe):** * Nhọrọ nke Editor - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society for Vascular Surgery * (Björck et al., * European Journal of Vascular and Endovascular Surgery *).
• ** American College of Gastroenterology (ACG) & American Gastroenterological Association (AGA, United States): *** ACG Clinical Guideline: Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia and Acute Mesenteric Ischemia *.
• ** Ogbe maka ịwa ahụ Vascular (SVS, United States):** Ntụziaka omume ahụike maka Ischemia na-adịghị ala ala na nnukwu mesenteric.
• ** National Institute for Health and Care Excellence (NICE) & Royal College of Surgeons of England (United Kingdom): *** Ịwa Ahụhụ Mberede na Nnukwu Ihe ize ndụ Dị Ukwuu Abdominal Pain Triage Pathways*.

Ntuziaka emetụtara¶

• Ụkwụ na-adịghị ahụ oyi na mberede na mkpọchi akwara akwara
• Mgbochi afọ, hernia kpagburu, na akara mberede volvulus
• Mgbasa aortic na mgbawa nke eriri afọ aortic aneurysm
• Appendicitis, appendix gbawara agbawa, peritonitis, na nnukwu mgbu afọ
• Ọbara ọgbụgba nke eriri afọ, vomiting, na melena