RÉSUMÉ
Objective To evaluate the effect of the single-person hyperbaric chamber on hemodynamics of superior mesenteric artery in the personnel rushing to the extremely high altitude area.Methods Sixty healthy young male subjects who traveled by car from the plains(890 m above sea level)to a very high altitude area(5 130 m above sea level)were randomly divided into a control group,a low-flow oxygen therapy group and a hyperbaric oxygen group,with 20 cases in each group.After entering the plateau area,no intervention was made in the control group;in the low-flow oxygen therapy group,low-flow oxygen therapy was performed once a day by means of nasal oxygen cannula(oxygen flow rate of 2 L/min,60 min/times);in the hyperbaric oxygen group,hyperbaric oxygen therapy was carried out once a day in a single-person hyperbaric oxygen chamber(pressuri-zation pressure of 0.25 MPa,60 min/times).The subjects in the three groups had their peak systolic velocity(PSV),resistance index(RI),and pulsation index(PI)of the main trunks of the SMAs and their grade 1 and 2 branches measured and compared using color Doppler ultrasound diagnostic instruments on days 30,60,and 90,respectively,after acute entry to the plateau.SPSS 19.0 software was used for statistical analysis.Results There were no significant differences in PSV,RI and PI of SMA and its 1 st and 2nd grade branches between the 3 groups 30 days after entry(P＞0.05).Sixty days after entry,the control group had the values of PSV statistically higher than those of the other two groups(P＜0.05);there were no significant differences between the low-flow oxygen therapy group and the hyperbaric oxygen group in the values of PSV(P＞0.05);the three groups had no obvious differences in the values of RI and PI(P＞0.05).Ninety days after entry,the control group had the values of PSV,RI and PI all significantly higher than those of the other two groups(P＜0.05);the low-flow oxygen therapy group had the values of PSV statistically higher than those of the hyperbaric oxygen group(P＜0.05),while the values of RI and PI not significantly different from those of the hyperbaric oxygen group(P＞0.05).Conclusion Single-person hyperbaric oxygen chamber significantly improves the SMA blood flow changes due to oxygen partial pressure reduction in the plateau,and thus is of significance for preventing ischemic enteropathy of the personnel rushing to the plateau.[Chinese Medical Equipment Journal,2023,44(10):59-63]
RÉSUMÉ
Objective To explore the diagnosis and treatment of mesenteric venous thrombosis secondary to long-term ischemic enteropathy.Methods The retrospective cross-sectional study was conducted.The clinical data of 36 patients with mesenteric venous thrombosis secondary to long-term ischemic enteropathy who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2009 to June 2017 were collected.Diagnostic methods:history inquiry,physical examination,laboratory test and image finding.Treatment methods:parenteral nutrition support,selective stage 1 bowel resection with anastomosis or stage 1 bowel resection and colostomy,definitive stage 2 operation for recovering digestive tract.Anticoagulation therapy was performed.Observation indicators:(1) clinical characteristics;(2) treatment;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to December 2017.Measurement data with skewed distribution were described as M (P25,P75) and M (range).Results (1) Clinical characteristics:① the main clinical manifestations:34,33,27,20,17 and 14 patients showed respectively discomfort after meal,abdominal pain,abdominal distension,nausea with vomiting,stop of analis exhaust and defecation and weight loss of different degree,and the worst patient lost 20 kg within 1 month.The clinical manifestations of 30 patients were more than 3.② The score of acute physiology and chronic health evaluation (APACHE)Ⅱ in 36 patients was 4 (2,6).③ Laboratory test:total protein (TP),albumin and prealbumin were 55.8 g/L (45.2 g/L,59.1 g/L),30.6 g/L (27.3 g/L,37.5 g/L) and 100.0 g/L (86.0 g/L,132.0 g/L),respectively,showing a decreased trend.④ Imaging finding:enhanced scans of abdominal CT showed the portal cavernous in 16 patients,the absence of main trunk of superior mesenteric vein with extensive collaterals in 12 patients,and dovelopment of portal vein and main trunk of superior mesenteric vein in 8 patients.One patients had intestinal edema and stenosis.X-ray contrast examination of digestive tract showed intestinal stenosis with mucosal erosion in 28 patients and complete intestinal obstruction in 8 patients.(2) Treatment:of 36 patients,24 underwent stage 1 bowel resection with anastomosis and other 12 received stage 1 bowel resection and colostomy (11 undergoing definitive stage 2 operation for recovering digestive tract and 1 refusing stage 2 operation due to advanced age).The length of resected bowel was 30 cm (15 cm,80 cm).One patient with stage 1 bowel resection with anastomosis was complicated with small bowel fistula,and was cured by conservative treatment.There was no complication in other patients.(3) Follow-up:all 36 patients were followed up for 3-10 months,with a median time of 6 months.During the follow-up,7 patients were complicated with secondary portal hypertension,5 of 7 were improved by symptomatic treatment,and 2 died of severe digestive tract bleeding;other patients had no related complications.Conclusions The discomfort after meal and bowel obstruction are the main clinical manifestations of mesenteric venous thrombosis secondary to long-term ischemic enteropathy.The abdominal CT with X-ray contrast examination benefits to diagnosis of patients with poor nutrition status and mild infection.The main strategy includes early surgical resection and postoperative anticoagulation therapy after bleeding risk evaluation.