暴发性胰腺炎的救治

A Study of Clinical Characteristic and Management in Patients with Fulminatant Acute Pancreatitis

目的:探讨暴发性胰腺炎(FAP)的临床特点及救治方法。方法:回顾性分析2004年6月-2010年6月我科收治的急性重症胰腺炎(SAP)84例,属于暴发性胰腺炎(FAP)33例,约占SAP的25%。并对33例FAP病人的临床特点和救治情况作一总结。结果:FAP组胰腺病变程度(CT分级)、病死率、低氧血症、腹腔室隔综合征(ACS)和多器官功能障碍综合征(MODS)发生率明显高于SAP组(5.2±0.5 vs 3.7±0.8、21.2%vs 14.2%、84.8%vs 22.6%、75.8%vs 25.0%和78.9%vs10.7%)。FAP组早期手术治疗21例成活17例,非手术治疗12例成活9例。结论:FAP的主要临床特征包括MODS发生率高、胰腺病变程度严重、早期发生低氧血症、腹腔室隔综合征(ACS)、高APACHEⅡ评分和高病死率。在ICU行监护及最大限度地加强治疗同时尽快缓解腹腔高压、控制持续全身炎症反应综合征(SIRS)是救治FAP的关键。

Objective：To investigate clinical characteristic and management in patients with fulminant acute pancreatitis （FAP）. Methods ：The clinical data of 84 severe acute pancreatitis and 33 fulminatant acute pancreatitis cases were admitted to our hospital from June 2004 to June 2010 were reviewed. Clinical characteristics and management of patients with fulminant acute pancreatitis（FAP） were studied. Results：FAP has higher mortality than severe acute pancreatitis （SAP） （21.2% vs 14. 2% ） , and had a higher incidence of hypoxemia and multiple organ dysfunction （MODS） （ 84. 8% vs22. 6% ;78.9% vsl0.7% ）. The effects of each method were ： 21 with early operation, 17 survived; 12 with nonoperation method, nine survived. Conclusion：FAP is characterized by MODS, severe extent of pathological changes of the pancreas, early hypoxemia, and abdominal compartment syndrome. Supportive measures and close supervision, i.e. ,early operation, improvement of hypoxemia, and elimination of inflammation mediators may be useful to FAP.