胆道梗阻程度在重症胆管炎病程中的作用及其临床意义

Effect of The Obstructal Degree of Biliary Tract in Acute Severe Cholangitis and its Clinical Significance

本文分析了我院近十年的36例重症胆管炎(ACST)患者,结果显示:依梗阻是否完全,ACST可分成急性梗阻化脓性胆管炎(AOSC)和急性化脓性胆管炎(ASC),前者发展凶猛,死亡率极高,后者则预后较好。另外本文采用44只日本种长耳家兔以不同胆道梗阻制成胆道管炎模型,结果也证实,完全梗阻组48小时血压下降幅度达7.6kpa(55mmHg),较不全梗阻组(4kpa)为高(p<0.05),作者认为:胆道梗阻程度是ACST病情发展的重要因素。文中发现血内毒素与血压变化并不平行,可能存在其它影响因素。

The authors surveyed 36 cases of acute severe cholangitis (AOST) treated from 1981 to 1990. The results showed that ACST would consist of acute obstructal suppurative cholangitis (AOSC) and acute suppurative cholangitis(ASC), depending on the obstructal degrees of biliary tract. 27 cases with AOSC had a high mortality(12/27) with the rapid development of septic shock; however, all the cases(9/9) with ASC survived at all with the slower develpment. of the other hand an experimental model of acute cholangitis was conducted in the Japanese big ear white rabbits in accordance with the various degrees of biliary obstruction. The results confirmed that the mean artial blood pressure (MAP) yielded a reduction of 7.6kpa(55mmHG) at complete obstructal group at 48 hr, it was much higher than that of 4kpa at partial obstructal group (P<0.01). The authors suggests that the obstructal degree of biliary tract is an important factor affecting the features development of ACST. and yet, it was observed that a significant fall of MAP(P<0.05) did not inversely paralled with the increase of blood endoroxim(p<0.05). The result indicated the existence of other factors making MAP decrease.