烧伤患者非闭塞性肠系膜缺血的评估--配对分析和治疗算法。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-08-30 DOI:10.1016/j.burns.2024.08.020

Florian Bucher, Nadjib Dastagir, Martynas Tamulevicius, Doha Obed, Thorben Dieck, Peter M. Vogt, Khaled Dastagir

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引用次数: 0

摘要

背景：烧伤可能导致胃肠道功能障碍，导致肠屏障功能障碍、腹腔隔室综合征和急性肠系膜缺血。在没有大血管闭塞的情况下，非闭塞性肠系膜缺血（NOMI）常常发生在重症监护烧伤患者身上：方法：从 2018 年 1 月 1 日至 2024 年 5 月 1 日，对汉诺威医学院整形、美容、手部和整形外科烧伤登记处进行了回顾性描述分析。根据关键变量和共同特征，将患有 NOMI 的烧伤患者与未患急性肠系膜缺血的烧伤患者进行配对：本研究共纳入 20 名患者。NOMI患者的血清乳酸有显著的统计学升高（p = 0.005），最有可能处于休克状态，需要使用血管加压药（p = 0.047）。NOMI队列的总体预后较差，其中80%的患者有死亡结果（p = 0.024）。共有四名患者接受了阿前列地尔动脉内给药：结论：NOMI对烧伤患者来说是一种潜在的致命疾病。目前缺乏敏感的生物标志物和准确的诊断工具来早期检测 NOMI 的发病，这是导致整体预后不良的一个主要因素。我们建议将动脉内注射阿普前列地尔作为一种新的靶向治疗NOMI的方法。

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Evaluation of non-occlusive mesenteric ischemia for burn patients – A matched-pair analysis and treatment algorithm

Background

Burn injuries may cause gastrointestinal dysfunction leading to intestinal barrier dysfunction, abdominal compartment syndrome, and acute mesenteric ischemia. In the absence of major vascular occlusion, non-occlusive mesenteric ischemia (NOMI) often occurs in critically ill intensive-care burn patients.

Methods

A retrospective descriptive analysis of the burn registry of the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery of Hannover Medical School was performed from 1st January 2018 to 1st May 2024. Burn patients with NOMI were matched with burn patients who did not acquire acute mesenteric ischemia based on key variables and shared characteristics.

Results

A total of 20 patients were included in this study. Patients with NOMI showed a statistically significant elevation in serum lactate (p = 0.005) and were most likely to be in a shock state requiring vasopressors (p = 0.047). Overall prognosis was poor for the NOMI cohort, 80 % of whom had a fatal result (p = 0.024). A total of four patients received intra-arterial administration of alprostadil.

Conclusions

NOMI represents a potentially fatal condition for the burn patient. The current lack of sensitive biomarkers and accurate diagnostic tools for the early detection of NOMI onset is a major factor behind the overall poor prognosis. We propose the intra-arterial administration of alprostadil as a novel approach to targeted treatment for NOMI.

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.