重症高脂血症性急性胰腺炎的临床特点及治疗研究

Clinical characteristics and treatment of severe hyperlipidemic pancreatitis

目的总结重症高脂血症性胰腺炎的临床特点和治疗经验。方法对2000年1月1日至2006年12月31日收治的22例重症高脂血症性胰腺炎患者和91例重症急性肥源性胰腺炎患者的临床资料进行回顾分析，比较两者的临床特点及治疗结局。结果重症高脂血症性胰腺炎患者入院时血、尿淀粉酶分别为（715±99）和（382±56）U／L，明显低于重症胆源性胰腺炎患者的（1551±107）和（773±66）U／L（P〈0．01）；且肺部感染发生率高55％（12／22），循环功能不全36％（8／22）、呼吸功能不全41％（9／22）、肾功能不全23％（5／22），明显高于重症胆源性胰腺炎患者的32％（29／91）、14％（13／91）、7％（6／91）和5％（5／91）（均P〈0．01）。重症高脂血症性胰腺炎患者死亡2例，重症急性胆源性胰腺炎患者死亡11例。结论重症高脂血症性胰腺炎患者常不伴有血、尿淀粉酶的显著升高，在治疗中臆注意积极治疗循环功能、呼吸功能和肾功能不全。

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis （SHLP）. Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis （SABP） hospitalized during January 1,2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were （715 ± 99） and （382 ± 56） U/L, respectively, significantly lower than those in SABP patients （1551 ± 107） and （773± 66） U/L, respectively （P 〈 0. 01 ）. About 55% （12/22） of SHLP patients had pulmonary infection, 36% （8/22） with circulatory failure, 41% （9/22） with respiratory failure and 23 % （5/22） with renal failure, all significantly higher than those in SABP patients SABP [32% （29/91）, 14% （13/91）, 7% （6/91） and 5% （5/91）, respectively, P 〈0. 01 ]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.