青、老年重症急性胰腺炎的临床对比研究

Study of the clinical charactistics of severe acute pancreatitis in youngth and older patients

目的 研究青、老年重症急性胰腺炎 (severeacutepancreatitis ,SAP)的临床特征 ,提高诊治水平。方法 回顾性分析1991年 1月～ 2 0 0 1年 12月收治的青、老年SAP 2 14例 ,其中青年SAP 98例 ,老年SAP 116例 ,对其病因 ,伴发疾病 ,临床特征 ,生化指标 ,严重程度 ,并发症及死亡率进行对比研究。结果 老年胆源性SAP占 5 6 0 % ,青年占 2 1 4% (P <0 0 1) ,在非胆源性SAP中 ,老年以高脂血症 ( 2 9 4% )和饮食因素 ( 2 1 6% )为主 ,青年以汹酒 ( 2 8 6% )和饮食因素 ( 2 7 3 % )为主。老年SAP合并慢性心肺疾病和糖尿病占 49 1% ,病变程度重 ,青年SAP占 12 4% ,病变程度轻 (P <0 .0 5 )。青年SAP以腹痛 ( 10 0 % )为主 ,定位准确 ,腹膜刺激征( 2 7 6% )明显 ,血淀粉酶升高占 90 8% ,老年SAP腹痛仅为 89 7% ,且定位不准 ,腹胀突出 ( 5 5 2 % ) ,低O2 血症 ( 5 3 4% )、神志改变( 2 3 3 % )较为明显 ,血淀粉酶升高仅为 74 1% ,两组间比较均有差异显著性 (P >0 0 5 )。而腹腔渗出 ,消化道出血 ,血钙降低 ,硷缺失两组比较均无差异显著性 (P <0 0 5 )。老年SAP伴有器官损害占 3 3 6% ,青年SAP为 19 4% (P <0 0 5 )。总死亡率 2 0 1% ,青、老年SAP死亡率分别为 11 2 %和 2 7 7% (P <0 0 5 ) ,青年死亡?

Objective To study the clinical charactistic of severe acute pancreatitis (SAP) in the youngth and the older, and improve the diagnostic level and therapentic effect.Methods Between 1990.1 and 2001.12, a consecutive series of 214 patients with SAP were included in the study.Among them, 98 were ≤45 yearsold and 116 were ≥60 years old. Etiology, con comitant disease, clinical and laboratory data, severe degree,complication and mortality were analysed.Results The biliary tract disease played a major role in the etiology of SAP in the older (56.0%), only 21.4% in the younger(P<(0.01)). In the (remaining), followed by hyperlipemia(29.4%) and high fat diet (21.6%) in the older, and by alcololism ((28.6%)) and high fat diet (27.3%)in the younger. The rate of concomitant disease of lung-heart and diabetes was 49.1% in the older of SAP, 12.4% in the younger of (P<0.05). The abdominal pain palyed the major role in the clinical symptoms in the younger (100%), followed by signs of peritoneal irritation (27.6%) and high blood amylase level(90.8%). With the older of SAP, abdominal pain was only 89.7%, high blood amylase level was 74.1%,and abdominal distension (55.2%), hypoxenia (54.3%) and vague mind (23.3%) palyed the major role in the clinical sysmptoms. The over all mortality rate was 20.1%, 11.2% in the younger, 27.7% in the older (P<0.05). The time of high death rate occurred in the period of acute react in the younger of SAP(6.1%), in the period of general infection in the older (16.4%). Conclusion There is a significance difference in clinical charactistic of SAP in the younger and the older. The morbidity would be reduced if alcololism and high fat diet could be avoided in the younger, and cholelithiasis, hyperlipemia and diabetes could be prevent in the older.Controlling infection is a key for low (decreasing) mortality in the older of SAP