Serum Lactic Acid Determines the Outcomes of CT Diagnosis of Pneumatosis of the Gastrointestinal Tract
Serum Lactic Acid Determines the Outcomes of CT Diagnosis of Pneumatosis of the Gastrointestinal Tract
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血清乳酸决定胃肠道积气的CT诊断结果
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
S. Vickers
中科院分区：
文献类型：
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作者：
M. Hawn;C. Canon;M. Lockhart;Q. González;Gregg I. Shore;Anthony Bondora;S. Vickers
胃肠道积气的计算机断层扫描 (CT) 诊断可以代表从良性过程到缺血性肠的广泛临床实体。本研究的目的是明确肠积气症 (PI) 的意义和结果。从 5/93 到 12/01 的所有 CT 扫描以及发现 PI 的结果均经过审查。 86 例 CT 扫描发现 PI，其中结肠是最常见的位置（51%），其次是小肠（36%）和胃（9%）。 40%的患者接受了手术，总体死亡率为42%，手术死亡率为47%。单变量分析表明血清乳酸 (LA) >2.0 mmol/L 之间存在显着相关性 [优势比 (OR) = 23.4； 95% 置信区间 (C.I.)，7.21–75.92] 和血清肌酐 >1.5 mg/dL（OR = 3.05；95% C.I.，1.25–7.42）与死亡率相关。年龄具有提示性，但不是死亡的显着危险因素（P = 0.09）。多变量分析发现血清 LA >2.0（OR = 30.37；95% CI，7.31–126.2）是死亡率的唯一显着预测因子。 PI 的 CT 诊断与显着的院内死亡率相关，尤其是老年人。诊断时血清 LA 水平 >2.0 mmol/L 与 80% 以上的死亡率相关。需要进行外科会诊来确定哪些患者需要紧急手术干预。
Computed tomography (CT) diagnosis of pneumatosis involving the gastrointestinal tract can represent a broad range of clinical entities from a benign process to ischemic bowel. The purpose of this study is to define the significance and outcome of pneumatosis intestinalis (PI). All CT scans from 5/93 to 12/01 with the finding of PI were reviewed. Eighty-six CT scans had the finding of PI, with the colon being the most frequent location (51%), followed by small bowel (36%) and gastric (9%). Forty per cent of patients underwent surgery, with an overall mortality rate of 42 per cent and a surgical mortality rate of 47 per cent. Univariate analysis demonstrated significant correlation between serum lactic acid (LA) >2.0 mmol/L [odds ratio (OR) = 23.4; 95% confidence interval (C.I.), 7.21–75.92] and serum creatinine >1.5 mg/dL (OR = 3.05; 95% C.I., 1.25–7.42) with mortality. Age was suggestive but not a significant risk factor for mortality (P = 0.09). Multivariate analysis found serum LA >2.0 (OR = 30.37; 95% CI., 7.31–126.2) to be the only significant predictor of mortality. CT diagnosis of PI is associated with significant in-hospital mortality, especially in the elderly. Serum LA level >2.0 mmol/L at time of diagnosis is associated with a greater than 80 per cent mortality. Surgical consultation is necessary to determine which patients need urgent surgical intervention.