晚期妊娠并发高血脂性重症急性胰腺炎的诊治

Hyperlipidemic severe acute pancreatitis in late pregnancy

目的探讨晚期妊娠并发高血脂性重症急性胰腺炎(SAP)的临床特点和诊治方法。方法回顾性分析12例晚期妊娠并发高血脂性SAP患者的临床资料。结果本组12例晚期妊娠并发SAP占同期SAP的20%,其中SAPⅠ型5例,SAPⅡ型7例,4例并发ARDS和多脏器功能不全综合征。血甘油三酯显著升高,平均为(29±14)mmol/L,全身炎症反应综合征明显,腹腔有大量乳糜样血性腹水。急诊行剖腹产后手术治疗。12例救治均成功。结论晚期妊娠并发高血脂性SAP是一种特殊类型的SAP,病情凶险,易致胎儿宫内窘迫。妊娠期控制高甘油三酯血症是预防的重要措施。

Objective To investigate clinical features, diagnosis and treatment of hyperlipidemic severe acute pancreatitis （HSAP） in late pregnancy. Methods A retrospective analysis was made on 12 HSAP cases. Results HSAP accounting for 20% （12/60） of severe acute pancreatitis （SAP） cases, develops during the period of 28 - 36 weeks of pregnancy. There were 5 cases in SAP type Ⅰ and 7 cases in SAP type Ⅱ. Multiple organ dysfunction syndrome （MODS） was complicated in 4 cases. HSAP is featured with severe hypertriglyceridemia （29 ± 14） mmol/L, significant systemic inflammatory response syndrome （SIRS）, large amount of lipidemic bloody ascites. All cases underwent successful. Cesarean section followed by pancreatic operation and were cured. Conclusion HSAP in late pregnancy is a specific type of SAP with fulminant clinical course leading to fetal distress. Effective management of pregnant hypertriglyceridemia helps to prevent HSAP.