伴有心房颤动的急性肠系膜上动脉栓塞13例临床分析

目的 分析13例伴有心房颤动的急性肠系膜上动脉栓塞（AMAE）患者的临床特点。方法 回顾性分析中山大学孙逸仙纪念医院2009年1月至2019年1月近十年住院的心房颤动并发AMAE患者的临床资料。结果 共检索到150006例心房颤动患者，有13例发生了AMAE，占比0.087%；其中男性8例，女性5例，年龄46~87岁，平均（65.5±5.3）岁。共检索到AMAE患者41例，其中伴有房颤者占比31.7%（13/41）。13例患者均以腹痛为首发症状，早期体征不明显，检验指标无特异性提示，由就诊到确诊的平均时间为47.9小时。13例患者总死亡率为46.15%（6/13），其中8人接受手术治疗，死亡3人；5人保守治疗，死亡3人。13例患者中仅2人服用抗凝药物，1人为华法令，1人为拜瑞妥，但凝血指标均未达标。结论 AMAE是房颤的少见并发症，但房颤是AMAE的重要危险因素；发病年龄大、体征和检验指标缺乏特异性导致临床诊断周期长、死亡率高。及时完善CTA、数字减影血管造影（DSA）等检查尽早确诊、准确判断病情作出恰当的治疗决策、规范应用抗凝药物是降低伴有房颤的急性肠系膜上动脉栓塞发病率和死亡率的重要手段。

Clinical analysis of 13 cases of acute mesenteric arterial embolus withatrial fibrillation

Objective To investigate clinical manifestation of acute mesenteric arterial embolism（AMAE） in patients with atrial fibrillation. Methods The retrospective study was performed on the clinical data of atrial fibrillation with acute mesenteric arterial embolism admitted into the Sun Yat-sen Memorial hospital of Sun Yat-sen University from January 2009 to January 2019. Results 15006 patients with atrial fibrillation were retrieved， of 13 cases received AMAE and the incidence was 0.087%. 8 cases were males and 5 were females. The ages range from 46 to 87 and the average age was 65.5±5.3 years old. 41 AMAE patientswere retrievedand the incidence of atrial fibrillation was 31.72%（13/41）. Belly pain was all the starting symptom of AMAE， with no characteristic signs and test results. The average time from seeking medical advice to making a definite diagnosis was 47.9 hours. The total mortality was 46.15%（6/13）， with death of 3 for 8 patients received surgery and death of 3 for 5 patients received conservation treatment. Just 2 patients took anticoagulant drugs，one was warfarin and the other was rivaroxaban， but none of the coagulation indicators met the standard. Conclusion AMAE is a rateof atrial fibrillation， while atrial fibrillation is the risk factor for AMAE. Age， lack of specific signs and test indicator result in a long diagnostic period and high mortality. Doing CTA or DAS as a valuable supplementary approach timely to make a definite diagnosis as early as possible， accurate judgment of illness to make a appropriate therapy decision and taking anticoagulant drugs regularly is effective in decrease of morbidity and mortality.