埃斯蒂斯指南：急性肠系膜缺血
ESTES guidelines: acute mesenteric ischaemia.
作者信息
Tilsed J V T, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco L A B, Ceolin M, D'Almeida A J G, Hilario S, Olavarria A L, Ozmen M M, Pinheiro L F, Poeze M, Triantos G, Fuentes F T, Sierra S U, Soreide K, Yanar H
机构信息
Surgery Health Care Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
Emergency Department, Istituto Clinico Città Studi, Milan, Italy.
出版信息
Eur J Trauma Emerg Surg. 2016 Apr;42(2):253-70. doi: 10.1007/s00068-016-0634-0.
PURPOSE
Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria.
METHODS
A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group.
RESULTS
The resultant recommendations are presented in this paper.
CONCLUSIONS
The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
目的
急性肠系膜缺血（AMI）约占急性住院病例的1/1000。若不进行治疗，AMI会导致肠系膜梗死、肠坏死、严重的炎症反应及死亡。早期干预可阻止并逆转这一过程，实现完全康复，但AMI的诊断困难，在肠坏死发生前未能识别AMI是导致该病高死亡率的原因。早期诊断和及时治疗是现代治疗的目标，但尚无随机对照试验来指导治疗，且已发表文献中综述与原始数据的比例很高。其中许多数据来自病例报告，且往往是小型回顾性系列研究，没有明确界定的治疗标准。
方法
欧洲创伤与急诊外科学会（ESTES）于2013年成立了一个研究小组，旨在制定AMI管理指南。使用医学主题词表（MeSH）关键词“肠系膜缺血”“肠缺血”和“肠梗死”进行了全面的文献检索。对相关文章的参考文献进行筛选以获取更多出版物。在全组对文献进行初步系统综述后，一个指导小组采用改良的德尔菲法提出问题。然后对证据进行审查以回答这些问题，并由全组制定并商定建议。
结果
本文给出了最终的建议。
结论
这些指南的目的是为临床实践提供建议，以改善患者的治疗效果。
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