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目的总结老年终末期肾衰竭合并缺血性肠炎患者的临床特点。方法回顾分析2000年1月至2010年2月收治的36例合并缺血性肠炎的终末期肾衰竭血液透析患者的临床资料。其中男17例,女19例,年龄60～91岁,平均77.5岁。结果本组终末期肾衰竭合并缺血性肠炎36例,占同期终末期肾衰竭患者的6.9%(36/520)。患者均以腹痛、血便为主要症状;白细胞为(26.4±8.2)×109/L,血红蛋白为(68±12)g/L,纤维蛋白原为(5.6±1.2)g/L,D-二聚体为(3.8±1.6)mg/L;B超检查无特异性;纤维结肠镜检查示病变区黏膜充血水肿、瘀斑、糜烂、黏膜下出血、血管网消失、肠腔狭窄;腹部CT示肠系膜上静脉增宽。予扩血管及活血化瘀治疗有效,34例2周内治愈,2例因拒绝治疗死亡。结论终末期肾衰竭血液透析患者缺血性肠炎发病率较高,症状无特异,容易误诊,内窥镜及腹部CT、血管造影是最主要的确诊手段,及早行扩血管及活血化瘀治疗可取得良好效果。
Objective To summarize the clinical features of elderly patients with end-stage renal failure and ischemic enteritis. Methods The clinical data of 36 patients with end-stage renal failure and hemodialysis with ischemic colitis admitted from January 2000 to February 2010 were retrospectively analyzed. There were 17 males and 19 females, aged from 60 to 91 years, with an average age of 77.5 years. Results The group of end-stage renal failure with ischemic enteritis in 36 cases, accounting for 6.9% (36/520) of patients with end-stage renal failure in the same period. All the patients had abdominal pain and bloody stool as the main symptoms. The white blood cells were (26.4 ± 8.2) × 109 / L, the hemoglobin was (68 ± 12) g / L and the fibrinogen was (5.6 ± 1.2) g / The body mass was (3.8 ± 1.6) mg / L; there was no specific B ultrasound examination; colonoscopy showed mucosal congestion and edema, ecchymosis, erosion, submucosal hemorrhage, disappearance of vascular network and intestinal stricture; colon CT showed mesentery Upper veins widened. To vasodilators and blood circulation treatment of effective, 34 cases cured within 2 weeks, 2 patients died of treatment refusal. Conclusions The hemodialysis patients with end-stage renal failure have a higher incidence of ischemic enteritis, no specific symptoms and easy misdiagnosis. Endoscopic and abdominal computed tomography and angiography are the most important diagnostic methods. Early vasodilatation and blood circulation may be used to treat Achieve good results.