多种微创方法联合个体化治疗重症急性胰腺炎

Multiple Minimally Invasive Therapy and Individualized Treatments Combination for Patients with Severe Acute Pancreatitis

目的分析多种微创方法联合个体化治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的价值。方法总结我院1998年9月至2008年10月期间收治的67例SAP患者的临床资料,均采用多种微创方法联合个体化治疗的方案。检测患者治疗前、后APACHEⅡ评分、CT积分、WBC计数、总胆红素、AST、血糖、淀粉酶、脂肪酶、C反应蛋白、肿瘤坏死因子-α、血尿素氮、肌酐及氧合指数(PaO2/Fi O2)的变化,并记录腹痛缓解时间、开腹手术率、死亡率、治愈率,住院时间、住院费用等。结果本组患者经治疗后各项检测指标均较治疗前明显改善(P<0.001)。腹痛缓解时间为(20.17±14.16)h,开腹手术率为6.0%(4/67),死亡率为7.5%(5/67),治愈率为92.5%(62/67),住院时间(30.85±28.37)d,住院费用(59295.78±34564.44)元。结论针对SAP患者每例个体的不同病因、严重程度、病期及合并症采用多种微创方法联合个体化治疗,可明显改善各项检测指标,提高治愈率。

Objective To evaluate the efficacy of multiple minimally invasive therapy and individualized treatments combination in severe acute pancreatitis.Methods The data of sixty-seven patients with severe acute pancreatitis between September 1998 and October 2008 undergoing multiple minimally invasive therapy and individualized treatments were analyzed retrospectively.The changes of APACHE Ⅱ score,CT score,WBC count,total bilirubin,AST,blood glucose,amylase,lypase,C-reactive protein,tumor necrosis factor-α,blood urea nitrogen,creatinine,and oxygenation index（PaO2/FiO2）were observed and compared between before and after treatment.Time of abdominal pain relieved,laparotomy rate,mortality rate,recovery rate,hospital stay,and cost of hospitalization were also observed.Results All the detected indexes improved significantly after treatments compared with those before treatments（P0.001）.Time of abdominal pain relieved was（20.17±14.16）h.Laparotomy rate was 6.0%（4/67）.Mortality rate was 7.5%（5/67）.Recovery rate was 92.5%（62/67）.Hospital stay was（30.85±28.37）d and cost of hospitalization was（59 295.78±34 564.44）yuan.Conclusions Multiple minimally invasive therapy and individualized treatments for cases of severe acute pancreatitis with different causes,course,severity of disease,and complications,could significantly improve the clinical indexes and recovery rate of severe acute pancreatitis.