重症急性胰腺炎并发胰性脑病14例临床分析

Clinical analysis of pancreatic encephalopathy during severe acute pancreatitis in 14 cases

目的探讨重症急性胰腺炎(SAP)并发胰性脑病(PE)的临床特点、发病机制及防治措施。方法回顾性分析重症急性胰腺炎并发胰性脑病患者14例的临床资料。结果本组SAP的PE发病率为18.42%(14/76),发病时间为20小时～天,平均5.5天,其中9例(64.28%)在病程2W内,5例(35.72%)在2W后或恢复期。男8例,女6例,年龄28～75岁,平均年龄50岁。9例(64.28%)行手术治疗,5例(35.72%)行保守治疗,死亡率分别为66.67%(6/9)和40.00%(2/5)。存活患者(=6)脑病症状持续3～7天,平均5.3天。全组病例在PE发病前或者同时均存在感染、低氧血症、水电解质紊乱、氮质血症、低蛋白血症和高血糖等因素。结论胰性脑病的发生可能是在胰酶对大脑损害作用的基础上多因素共同作用的结果。早期PE的发生可能是SAP的急性全身炎症反应所致多脏器衰竭(MOF)的一部分。迟发性PE(>2W或发病于恢复期)与维生素B1缺乏和营养不良有关。治疗除手术、抑制胰酶的分泌和抗感染外,给予充足的营养和维生素B1至关重要。

Objective To explore the manifestation,pathogenesis,prevention and treatment of pancreatic encephalopathy(PE) in severe acute pancreatitis(SAP).Methods Fourteen cases of pancreatic encephalopathy with severe acute pancreatitis were studied retrospectively.Results In this group,PE incidence was 18.4%(14/76) compared to the total SAP cases.Fourteen patients were complicated by PE within 20 hours～43days(average 5.5 days)[9 (64.28%) within 2 weeks, and 5(35.72%) after 2 weeks or in recovery period].Eight patients were male and six female, with an average of fifty years(range 28～75 years). Nine patients (64.28%) received surgery and Five 35.72% conservative treatment, with a mortality of 66.7%(6/9) and 40.00%(2/5),respectively. The major encephalopathic manifestation of the survivors(n=6) lasted for 3～7 days (average 5.3 days). PE occurred often preceded by or accompanied with such agents as infection, hypoxemia, waterelectrolyte disturbance, azotemia, hypoproteinemia and hyperglycosemia etc.Conclusion On the basis of the harm that pancreatin does to the brain, the attack of PE is probably a result of multi-factors. Perhaps, PE in the early stage of SAP(<2 weeks) is a part of multiple organ failure (MOF) which results from acute systemic inflammatory reaction. Delayed PE in the late stage(>2 weeks or in recovery period) is probably attributed to deficiency of VitB1 and nutrition. Apart from surgical treatment, inhibition of pancreatin secrelion and anti-infection, prescribing adequate nutrition and VitB1 are of crucial importance.