酒精相关性重症急性胰腺炎的临床探讨

Clinical investigation of alcohol-related severe acute pancreatitis.

目的 探讨酒精相关性重症急性胰腺炎（ARSAP）的临床特点。方法 2001～2004年我院共收治重症急性胰腺炎（SAP）721例，符合纳入标准并剔除排除标准者347例，分成ARSAP组（77例）和对照组（270例），对比分析其年龄、性别、入院时Ranson评分、CT评分、APACHEⅡ评分、血糖、血清三酰甘油、并发症及后期感染率和病死率。结果 两组年龄无统计学差异（P〉0．05），ARSAP组男性的构成比明显高于对照组（P〈0．01），入院时两组Ranson评分、CT评分及血糖无统计学差异（P〉0．05），但ARSAP组APACHEⅡ评分和血清三酰甘油水平明显高于对照组（P〈0．05），ARSAP组ARDS和上消化道出血的发生率与对照组无统计学差异（P〉0．05），急性肾功能衰竭、肝功能不全、休克、心功能衰竭、脑病、感染的发生率及病死率明显高于对照组（P〈0．05）。结论 ARSAP患者以男性为主，并发症多，病死率高；治疗的关键是，早期诊断，及时体液复苏，促进酒精的排泄，改善微循环以及对症支持治疗；做好卫生知识宣传，改变酗酒的不良嗜好，是预防ARSAP的有效措施。

Objective To investigate clinical characteristics of alcohol-related severe acute pancreatitis （ARSAP）. Methods From 2001 to 2004, 721 cases of SAP were treated in our hospital, of which 347 cases that met the inclusion and exclusion criteria were enrolled in the present study. They were divided into ARSAP group （77 cases） and control group （270 cases）. Age, gender, Ranson scores, CT scores, acute physiology and chronic health evaluation Ⅱ scores （APACHE Ⅱ scores）, serum glucose, serum triglyceride （TG）, morbidity and mortality of the two groups were compared and analyzed. Results There were no significant differences in age, Ranson score, CT score and serum glucose between the two groups （P 〉 0.05）. APACHE Ⅱ score, serum TG and man ratio were higher in ARSAP group than those in control group （P 〈 0. 05）. The incidences of renal failure, hepatic failure, cardiovascular failure, shook, encephalopathy, infection and mortality were higher in ARSAP group than those in control group （P 〈 0. 05）, while the incidences of acute respiratory distress syndrome and gastrointestinal hemorrhage were not significantly different between the two groups （P 〉 0. 05）. Conclusions Men are more susceptible to ARSAP, with higher mortality and morbidity. Successful treatment of ARSAP depends on early diagnosis, timely body fluid resuscitation, facilitation of alcohol excretion, improvement of microcirculation and appropriate symptomatic and supportive treatment. Promoting health education and breaking up the bad habit of alcohol abuse are essential for the prevention of ARSAP.