早期器官功能障碍的监测在重症急性胰腺炎治疗方案选择中的意义

Detection of early organ dysfunction for the selection of treatment strategy on severe acute pancreatitis

目的探讨影响重症急性胰腺炎合并早期器官功能障碍治疗效果的因素和治疗方案的选择。方法收集2007年7月至2008年12月连续收治的167例重症急性胰腺炎患者的临床资料，分析出现早期器官功能障碍患者的临床特点、病情演变趋势和治疗结果。分析正规非手术治疗、手术治疗及时机对治疗效果的影响。结果167例患者中，68例（40．72％）出现了不同程度的早期器官功能障碍，其中单一器官功能障碍39例（57．4％），2个及2个以上器官功能障碍29例（42．6％）。最常累及器官包括：心血管系统32例（47．1％）、肺脏24例（35．3％）和肾脏20例（29．4％）。高龄（P〈0．05）、APACHE Ⅱ评分高（P〈0．05）是重症急性胰腺炎合并早期器官功能障碍预后不良的指标，早期手术干预有助于降低病死率。结论重症急性胰腺炎合并早期器官功能障碍患者的病死率与患者的年龄、器官功能障碍严重程度相关。治疗方案应采用正规非手术治疗包括合理液体复苏、去除病因治疗，同时结合手术治疗。急性反应期的手术治疗应根据病情演变趋势、器官功能障碍程度加以判断，手术应在坏死感染发生之前进行。SOFA评分可作为手术指征判断的参考指标。

Objective To investigate the severity related influencing factor and treatment strategy of severe acute pancreatitis with early organ dysfunction. Methods From July 2007 to December 2008,167 patients with severe acute pancreatitis were treated in the Surgical Department of Ruijin Hospital. The relationships between the happening of early organ dysfunction and outcome of the patients were observed, with operative or nonoperative treatment strategy. Results Among 167 patients ,68 patients have early organ dysfunction,in which 39 with single organ dysfunction and 29 with multiple organ dysfunction. The early organ dysfunction were involved in 47. 1% in cardiovascular system, 35.3% in lung and 29. 4% in kidney. Aging（P 〈0. 05） and higher APACHE Ⅱ score（P 〈0. 05） predicted a poor prognosis,which were benefit from early operation. Conclusions The mortality of the patients with SAP is related to age, and the degree of organ dysfunction as well. In the first phase of the disease, the selection of operation depends on the trends and the degree of early organ dysfunction before infected necrosis happens, with the aid of SOFA score as a scale.