85例急性重型胰腺炎死亡原因分析

Analysis of death cause of 85 cases with acute severe pancreatitis

目的：探讨影响胰腺炎病死率的因素。方法：８５例急性重型胰腺炎（ＡＳＰ）死亡患者按时间划分为３个阶段：１９８４年～１９９０年为Ⅰ阶段，１９９１年～１９９３年为Ⅱ阶段，１９９４年～１９９７年为Ⅲ阶段，分析不同时期ＡＳＰ的死亡原因。结果：Ⅰ、Ⅱ、Ⅲ阶段手术率逐渐降低，分别为７７．５９％，５４．５５％和２９．２９％（Ｐ均＜０．００５），手术组病死率分别为４７．７８％，２０．３７％和１５．５２％（Ｐ均＜０．００５）；３阶段非手术组病死率分别为１５．３８％，１３．３３％和８．５７％。Ⅰ和Ⅲ阶段非手术组病死率低于手术组（Ｐ均＜０．０５），且Ⅲ阶段合计死亡２１例，病死率为１０．６１％，低于Ⅰ阶段病死率（Ｐ＜０．０５）。结论：早期手术、误诊误治、并发症处理不及时、营养不良与死亡密切相关，休克和急性呼吸窘迫综合征（ＡＲＤＳ）是早期死亡的主要原因，胰周脓肿和多器官衰竭（ＭＯＦ）是后期死亡的主要原因，严格掌握手术指征非常重要。

Objective:To explore the factors related with mortality of pancreatitis.Methods:Eightyfive died cases of acute severe pancreatitis (ASP) were divided into 3 stages according to different periods:1984 to 1990 as stageⅠ;1991 to 1993 as stage Ⅱ and 1994 to 1997 as stage Ⅲ.Then,to analyse the death cause of ASP in different periods.Results:The operation rates were decreased gradually,there were 77 59%,54 55% and 29 29% in stage Ⅰ,Ⅱ and Ⅲ respectively (all P <0 005),the mortality in operation group was 47 78%,20 37% and 15 52% respectively (all P <0 005);however,the mortality of nonoperation group was 15 38%,13 33% and 8 57% in stage Ⅰ,Ⅱ and Ⅲ respectively;the mortality of nonoperation group in stage Ⅰ and Ⅲ was lower than that in operation group (all P <0 05).On the other hand,21 cases died in stage Ⅲ,mortality was 10 61%,it was lower than stage Ⅰ ( P <0 05).Conclusions:Early operation,wrong diagnosis,inadequate treatment,interventing complication lose time and mulnutrition were factors that close related to death.In addition,shock,acute respiratory distress syndrome (ARDS) were main etiology of death in early period;however,peripancreas abscess and multiple organ failure (MOF) were the main etiology of death in later period,so it is important to grasp strictly the operation indication.