急性出血坏死性胰腺炎死亡因素的分析(附112例报告)

The analysis of factors affecting the mortality of acute hemorrhagic necrotizing pancreatitis: a report of 112 cases

目的探讨急性出血坏死性胰腺炎（ＡＨＮＰ）的死亡因素。方法将１１２例病人分为死亡组和存活组，对有关预后指标进行对比和统计学处理。根据ＣＦ或术中所见将胰腺坏死的程度分为轻，中，重三级。比较每个级别保守治疗和手术治疗死亡率的差异及两种手术方式死亡率的差异。结果病人的平均年龄、性别比、发病时间极为相近。早期休克、早期ＡＲＤＳ及体温、血象和血糖值显著升高的发生率在两组间差异无显著意义与死亡有关的主要因素为：①胰腺坏死严重；②治疗方案不当；③手术方式不妥。结论对胰腺轻度和中度坏死的病例宜以保守治疗为主。对重度坏死的病例应先严格保守治疗４８～７２小时，无效果者宜及时中转手术治疗。术前需纠正休克或成人呼吸窘迫综合症（ＡＲＤＳ），术中应充分游离胰腺，并行十二指肠造瘘。如此可明显降低病人的死亡率和各种并发症的发生率，最大限度地保留胰腺内外分泌功能。

Objective To analyse the factors affecting the mortality of acute hemorrhagic necrotizing pan creatitis (AHNP). Methods One hundred and twelve patients with AHNP were retrospectively divided into twogroups-the dead and survivors. Some parameters were analysed statistically. Results The average age, sex ratioand the of onset of illness of the two geroups wery similar. The differences of early shock, early ARDS, highbody teukocytosis and high blood sugar between the two groups were not signficant. The importantfactors affecting the mortality were: ①severe pancreatic necrosis; ②incorrect therapeutic strategy; ③improper sur gical methods. Conclusion The patients with mild or moderate AHNP should mainly receive conservative heatment, while those with severe AHNP should undergo operation if the symptoms could not be alleviated by conservative treatment for 48-72 hours. The early syock and ARDS should be corrected before sergical intervantion, theswelling pancreas should be dissected fully and duodenostomy should be performed in operation.