100例老年重症急性胰腺炎临床研究

Clinical study on 100 cases of severe acute pancreatitis in aged patients

目的：分析老年重症急性胰腺炎（severe acute pancreatitis，SAP）的特点，探讨其诊疗手段。方法：对2003年1月-2005年12月收治的100例老年（55～85岁）SAP患者进行回顾性分析，并与221例同期的非老年SAP患者（11～54岁）的临床资料进行对比研究。结果：100例老年SAP患者共发病112次，发病原因以胆源性和高脂血症多见。SAP老年组的急性生理和慢性健康评价指标Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）和Ranson评分均明显高于对照组（P〈0．01），而两组Balthazar评分的差异则无统计学意义（P〉0．05）。老年组的患者更容易出现血钙和血白蛋白降低以及血天门冬氨酸氨基转移酶升高（P〈0．05），肝、肾、脑等脏器功能受损率和病死率也明显高于对照组（P〈0．05）。结论：老年SAP的病因主要是胆源性和高脂血症。其临床症状不典型，并发症较多，如肺、胃肠、肝、肾、脑等脏器的损害和感染问题。中西医结合个体化及分阶段辨证施治是有效的治疗手段。

Objective： To analyze the clinical features of severe acute pancreatitis （SAP） in aged patients, and to explore the measures of its diagnosis and treatment. Methods： The clinical data of 100 aged patients （55-85 years old） with SAP admitted from January 2003 to December 2005 were reviewed and compared with those of 221 non-aged SAP patients （11-54 years old） admitted at the same period. Results： Totally 112 times of onset occurred in 100 aged patients, and the main causes for senile SAP were biliary diseases and hyperlipemia. Both acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ ） and Ranson scores of the aged patients with SAP were higher than those of the control group （ P〈0.05） ;while there was no significant difference in Balthazar score between the two groups（ P〉0.05）. The incidences of low serum calcium, low albumin and high aspartate aminotransferase （ P 〈0.05）, liver, kidney or brain impairment as well as the mortality were higher in the senile SAP group than those in the control group（ P〈0.05）. Conclusions, Biliary disease and hyperlipemia are the main causes of senile SAP, which lacks characteristic clinical symptoms and is often associated with multiple complications such as infection and lung, gastrointestinal tract, liver, kidney, and brain impairment. Individualized differential treatment with integrated traditional Chinese and Western medicine based on stage classification is an effective approach.