胰腺炎并发胰性脑病37例临床分析

Acute pancreatitis complicated with pancreatic encephalopathy: analysis of 37 clinical cases

目的探讨胰腺炎并发胰性脑病(PE)的临床表现、诊断、鉴别诊断及可能诱因。方法回顾性分析5年来上海6所医院急性胰腺炎并发PE37例患者的临床资料。结果37例PE中男性24例,女性13例,平均年龄53岁(25～80岁)。按Ranson诊断标准33例为重症急性胰腺炎(SAP),4例为轻症急性胰腺炎(MAP),其中迟发性PE(DPE)6例,15例发病前有胰腺手术史。PE死亡率56.8%,DPE为66.7%。临床表现和诊断无特异性,血淀粉酶水平与PE严重程度无相关性。PE出现时常伴发低氧血症和急性呼吸窘迫综合征、水电解质紊乱、氮质血症、消化道出血等并发症。结论PE是胰腺炎发病过程中的严重并发症,死亡率高,多在重症胰腺炎中伴发。在PE的发病过程中,有些因素也可引起胰腺炎患者的精神症状,如低氧血症、Wernicke脑病等,临床上较易混淆,为确诊带来困难。

Objective To discuss clinical presentation, diagnosis, differential diagnosis and possible contributing causes of pancreatic encephalopathy （PE）. Methods 37 patients with encephalopathy during the course of acute pancreatitis （AP） from six hospitals in past 5 years were analyzed retrospectively. Results Of the 37 AP patients, 24 were males and 13 females ranging in age from 25 to 80 years with a mean of 53 years. According to Ranson criteria, there were 33 PE with severe acute pancreatitis （SAP） and 4 with mild acute pancreatitis （MAP）, including 6 cases of delayed PE （DPE, where PE occurred 14 days after AP onset）. 15 patients received pancreatic operation. The mortality of PE as a whole was 56.8%, and 66.7% in DPE. The clinical manifestation of PE was not characteristic. No correlation was found between the serum amylase level and the severity of PE. PE was usually associated with hypoxemia, acute respiratory distress syndrome （ARDS）, waterelectrolyte disturbance, nitremia and gastrointestinal hemorrhage. Conclusions PE is a serious complication in the progress of pancreatitis, which is often associated with SAP, usually leading to high mortality. Many factors, including hypoxemia and Wernicke Encepholapathy, may contribute to mental disturbance similar to psychiatric symptoms of PE, which often confuses differential diagnosis of PE in clinical practice.