重症急性胰腺炎后多器官衰竭

Multiple organ failure in patients with severe acute pancreatitis

本文分析我院过去16年间连续收治的重症急性胰腺炎70例及其中并发MOF者17例,以探讨影响重症胰腺炎临床治愈率的限制性因素。本组总病死率为20.0％,其中12例死亡与MOF有关,占85.7％;MOF的病死率高达70.6％。于胰腺炎病程不同时期发生的MOF具有不同的临床过程或模式,可分为早期速发单相型和后期迟发双相型。与重症胰腺炎后MOF有关的发病因素包括早期循环休克、胰腺脓毒症及重度胰坏死等,后者可能是MOF发病中的主导因素。重症胰腺炎后MOF的临床过程以显著的全身炎性反应为特征,由局部胰腺毒性病灶始动的失控的全身炎性反应可能是重症胰腺炎导致MOF的共同病理通路。

In order to clarify the limitative factors in the management of severe acute pancreatitis (SAP) especially the problems of the complicated multiple organ failure (MOF),70 cases of SAP,of which 17 were complicated with MOF,admitted to our hospital in the past 16 years were reviewed.The overall mortality rate of the series was 20.0% (14/70),and the death of 12 cases out of the 14 was associated with MOF (85.7%) and that of the other 2 with single organ failure (14.3%).MOF occurred in 17 cases with a mortality rate of 70.0%.Two patterns of MOF manifestations identified:A rapid single-phase of MOF was found in 7 cases.It developed rather early after the onset of SAP and was associated with severe pancreatic necrosis and early shock.And a delayed two-phaseof MOF was seen in 10 cases.It developed progressively with a lagging interval and from the pancre-atic necrosis and subsequent infection.The clinical manifestations of MOF were characterized by a severe and systemic inflammatory response.It is believed that the systemic inflammatory response trigged by the septic material released from the pancreatic necrotic focus seems to be the pathological channel to link SAP with MOF.