A carregar...
Publicação
Isquémia mesentérica aguda : uma análise de cinco anos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 810.32 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A Isquémia Mesentérica Aguda (IMA) é definida como obstrução aguda ou diminuição do fluxo sanguíneo arterial ou venoso do território vascular mesentérico superior, conduzindo a isquémia, necrose intestinal e, na ausência de intervenção, morte. Distinguem-se quatro etiologias de IMA: embolia arterial, trombose arterial, trombose venosa e não oclusiva. Apesar dos avanços na abordagem diagnóstica e cirúrgica, a mortalidade mantém-se elevada (50-80%).
Objectivos: Caracterizar a demografia, abordagem diagnóstica e a terapêutica dos doentes com diagnóstico de IMA, explorando-se factores condicionantes/determinantes de mortalidade dos doentes.
Métodos: Foram revistos todos os casos de IMA admitidos no Hospital Garcia de Orta num período de 5 anos. Levantaram-se dados referentes à demografia, clínica, comorbilidades, parâmetros analíticos (incluindo Razão Neutrófilo-Linfócito e RDW), imagiológicos e terapêutica. Calculou-se o Tempo de Isquémia (TIsq) e aferiu-se o Valor Preditivo Positivo (VPP) e Sensibilidade (S) da Angio-TC para achados sugestivos de necrose intestinal.
Resultados: 36 doentes com IMA (idade mediana de 77,5 anos). A embolia arterial contabilizou 30,6%; Hipertensão Arterial e Diabetes foram as comorbilidades mais frequentes. A dor abdominal foi o achado mais frequente (100%), seguido de náuseas e/ou vómitos (77,8%), associado a taquicardia (22%) e hipotensão (11%). Intervencionaram-se 21 doentes e 15 doentes receberam Medidas de Conforto. O TIsq foi 65,82h; a mortalidade foi 61,1%. A Angio-TC apresentou S de 38,5% e VPP de 90,9%.
Discussão/Conclusão: A caracterização demográfica sobrepôs-se ao descrito na literatura na maioria dos parâmetros avaliados. A avaliação do índice Charlson e RDW revelou que pode existir uma associação entre estes parâmetros e a mortalidade. O TIsq revelou-se superior ao esperado, com 44% dos doentes que se apresentaram tardiamente, fora da janela temporal passível de cura. Nos doentes submetidos a ressecção intestinal, a laparostomia e cirurgia “second-look” permitiram a confecção de anastomoses diferidas com baixa da morbi-mortalidade neste grupo de doentes.
Introduction: Acute mesenteric ischemia (AMI) is defined as acute obstruction/decreased arterial or venous blood flow in the upper mesenteric vascular territory, leading to ischemia, intestinal necrosis and, in the absence of intervention, death. There are four etiologies of AMI: arterial embolism, arterial thrombosis, venous and non-occlusive thrombosis. Despite advances in diagnostic tests and surgical approach, the mortality rate remains high (50-80%). Objectives: To analyze the demography, diagnostic approach and therapy of patients with AMI and eventual conditioning factors/determinants of patient mortality. Methods: All cases of AIM admitted to Hospital Garcia de Orta for five years were reviewed. Demographic and clinical data were collected (including Neutrophil-Lymphocyte Ratio and RDW), imaging and therapeutics. Ischemic time (IscT) was calculated and the Positive Predictive Value (PPV) and Sensitivity (S) of Angio-CT were measured for findings suggestive of intestinal necrosis. Results: 36 patients with AIM (median age 77.5 years). Arterial embolism accounted for 30.6%; arterial hypertension and diabetes were the most frequent comorbidities. Abdominal pain was a universal finding (100%), nausea and/or vomiting were present in 77.8%, tachycardia in 22% and hypotension in 11%. 21 patients were operated on while 15 patients received Palliative Measures. The average IscT was 65.82h; mortality was 61.1%. Angio-CT had a sensitivity of 38,5% and a PPV of 90.9%. Discussion / Conclusion: The demographic characterization overlapped the findings described in the literature for most parameters. The Charlson Index and RDW seem to have an association with mortality. The IscT proved to be higher than expected, with 44% of patients presenting outside the timeframe for surgical cure. In patients undergoing intestinal resection, laparostomy and second look surgery allowed for a higher rate of enteric anastomoses with low morbidity and mortality.
Introduction: Acute mesenteric ischemia (AMI) is defined as acute obstruction/decreased arterial or venous blood flow in the upper mesenteric vascular territory, leading to ischemia, intestinal necrosis and, in the absence of intervention, death. There are four etiologies of AMI: arterial embolism, arterial thrombosis, venous and non-occlusive thrombosis. Despite advances in diagnostic tests and surgical approach, the mortality rate remains high (50-80%). Objectives: To analyze the demography, diagnostic approach and therapy of patients with AMI and eventual conditioning factors/determinants of patient mortality. Methods: All cases of AIM admitted to Hospital Garcia de Orta for five years were reviewed. Demographic and clinical data were collected (including Neutrophil-Lymphocyte Ratio and RDW), imaging and therapeutics. Ischemic time (IscT) was calculated and the Positive Predictive Value (PPV) and Sensitivity (S) of Angio-CT were measured for findings suggestive of intestinal necrosis. Results: 36 patients with AIM (median age 77.5 years). Arterial embolism accounted for 30.6%; arterial hypertension and diabetes were the most frequent comorbidities. Abdominal pain was a universal finding (100%), nausea and/or vomiting were present in 77.8%, tachycardia in 22% and hypotension in 11%. 21 patients were operated on while 15 patients received Palliative Measures. The average IscT was 65.82h; mortality was 61.1%. Angio-CT had a sensitivity of 38,5% and a PPV of 90.9%. Discussion / Conclusion: The demographic characterization overlapped the findings described in the literature for most parameters. The Charlson Index and RDW seem to have an association with mortality. The IscT proved to be higher than expected, with 44% of patients presenting outside the timeframe for surgical cure. In patients undergoing intestinal resection, laparostomy and second look surgery allowed for a higher rate of enteric anastomoses with low morbidity and mortality.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Isquémia mesentérica aguda Serviço de urgência Mortalidade Tempo de isquémia Angio-TC