急性胰腺炎诊治方法变迁与预后的关系(附265例临床分析)

The effect of diagnostic and therapeutic variation on prognosis of acute pancreatitis:Report of 256 cases

目的 :评价急性胰腺炎 (AP)的预后因素以及诊断和治疗方法的变迁对预后的影响。方法 :将 2 6 5例 AP临床和治疗因素分组 ,用 χ2 检验进行率比较。结果 :体温≥ 39℃的急性出血坏死性胰腺炎 (AHNP)发生率明显高于水肿型胰腺炎(ASP) ,体温≥ 39℃的 AHNP病死率明显高于 <39℃者 ;血尿淀粉酶均升高者 AP病死率明显低于正常者 (P <0 .0 5 ) ;血糖≥ 11.0 m mol/ L 者 AP病死率明显高于正常者 (P <0 .0 5 ) ;血钙 <2 .0 mm ol/ L 者 AP病死率明显高于正常者 (P <0 .0 5 ) ;经 B超、CT检查 AP病死率明显下降 (P <0 .0 5 ) ;非手术的综合性治疗 AP病死率明显低于手术治疗 (P <0 .0 1) ;行手术治疗 AHNP病死率与非手术的综合性治疗相近。结论 :血尿淀粉酶下降 ,体温≥ 39℃、血糖升高、血钙下降是 AP的预后危险因素 ;CT等新的诊断方法提高 AP诊断符合率 ,降低了病死率 ;早期手术并不能降低 AHNP的病死率 ,根据病人病情决定 AP治疗方法会比早年的早期手术有更好的疗效。

Objective:To evaluate the effect of diagnostic and therapeutic variation on prognosis of acute pancreatitis Method:256 patients with acute pancreatitis were treated between 1963 and 1998 Clinic data were analysed by χ 2 test Result:the morbidity of acute hemorrhagic necrotizing pancreatitis(AHNP) was significantly higher than that of acute swelling pancreatitis in patients with temperature≥39℃ The mortality of AHNP with temperature≥39℃ was strikingly higher than that of AHNP with temperature<39℃ When serum and urine amylopsin droped,mortality of AP became higher Mortality of AP was higher if serum sugar≥11 0mmol/L and serum calcium<2 0mmol/L Mortality of AP droped after B model sonography and CT Mortality of AP in patients treated with non operation was lower than that with operation Mortality of non operation and operation was similar in patients with AHNP Conclusion:drop serum and urine amylopsin,temperatures≥39℃,raised blood sugar and low serum calcium are hazard prognostic factors of AP New diagnostic procedures can reduce mortality of AP Therapeutic options depending on sick status will be better than early operation in patients with AP