重症急性胰腺炎合并麻痹性肠梗阻的临床特点及其预后

Clinical features and prognosis of severe acute pancreatitis with associated paralytic ileus

目的:探讨重症急性胰腺炎(SAP)病程中麻痹性肠梗阻(PI)临床特点,分析其对预后的影响。方法:回顾性分析2011年2月—2012年3月间收治的45例SAP患者临床资料,其中合并P(ISAP+PI组)19例,无合并PI(SAP组)26例,分析SAP合并PI临床特点及其预后。结果:CT显示SAP+PI组积气积液(小肠或结肠)、巨大肠袢、肠管水肿发生率分别为100%,73.7%,78.9%,而SAP组无前2项表现,肠壁水肿发生率为50.0%(P=0.048);与SAP组比较,SAP+PI组胃潴留量,肠内营养不耐受(FI)发生率及黄疸发生率增加,腹腔压力增高、腹腔压力变化幅度增大(均P<0.05);此外,SAP+PI组较SAP组住院时间、费用以及病死率明显增加(均P<0.05)。单因素分析显示,FI,腹腔压力>15 mmHg,黄疸,胃潴留量>250 mL/d是影响SAP患者预后的重要因素(均P<0.05)。结论:SAP合并PI的CT影像主要表现为积气积液与巨大肠袢等。SAP合并PI患者常伴有腹腔高压、黄疸、肠内营养不耐受、胃潴留等并发症,从而增加患者病死率。

Objective： To investigate the characteristics of paralytic ileus（PI） during the course of severe acute pancreatitis（SAP） and its influence on the prognosis. Methods： The clinical data of 45 patients with SAP admitted from February 2011 to March 2012 were reviewed.Of the patients,19 cases were complicated with PI（SAP＋PI group） and 26 cases without PI（SAP group）.The clinical characteristics of SAP with associated PI and its prognosis were analyzed. Results： CT scan showed the incidence of the accumulation of gas and fluid in small intestine and colon,hugely distended bowel loop and bowel wall edema in SAP＋PI group was 100%,73.7% and 78.9% respectively,while in SAP group,the first two signs were not obvious and the incidence of bowel wall edema was 50%（P=0.048）.Compared with SAP group,the gastric retention volume,incidence of feeding intolerance（FI） and jaundice,and the intra-abdominal pressure（IAP） as well as the extent of IAP change were significantly elevated in SAP＋PI group（all P〈0.05）.In addition,the length and cost of hospitalization,and mortality rate were increased in SAP＋PI group compared with SAP group（all P〈0.05）.Univariate analysis indicated that FI,IAP（15 mmHg）,jaundice and gastric retention volume（250 mL/d） were important factors affecting the prognosis of SAP patients（all P〈0.05）. Conclusion： The predominant signs of SAP with PI in CT images are the accumulation of gas and fluid and hugely distended bowel loop.SAP patients with associated PI are frequently complicated by intra-abdominal hypertension,jaundice,FI and gastric retention,which may contribute to the increased mortality of these patients.