重症急性胰腺炎并发消化道出血临床分析

Severe acute pancreatitis complicated with gastrointestinal bleeding:clinical analysis of 19 cases

目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)并发消化道出血的临床特点与治疗方法。方法回顾性分析2008年1月—2012年3月收治的163例SAP患者的临床资料,伴消化道出血的为出血组19例,无消化道出血的为对照组144例,分析SAP并消化道出血的临床诊治特点。结果 19例患者发生消化道出血,占11.66%。出血组在48 h APACHII评分、Ranson评分、CT严重度指数、PaO2、动脉血pH值、休克、严重的全身感染、多器官功能障碍综合征(multiple organ dysfunction syndrome or failure,MODS or MODF)、急性肺损伤(acute ung injury,ALI)或急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、肾功能不全、机械通气时间、肝素化持续静脉-静脉血液滤过时间(hepairnize continuous vein-vein hemodiafiltration time,CRRT)、PLT、病死率方面的差异均有统计学意义(均P<0.05),而在年龄、性别、体重指数、TBIL、DBIL、ALT、AST、PT、APTT、使用激素的差异均无统计学意义(均P>0.05)。结论 SAP并发消化道出血与SAP病情严重程度相关,常伴有多种并发症,并与治疗中机械通气时间、肝素化CRRT相关。

Objective To investigate the clinical features and treatment of severe acute pancreatitis （SAP） complicated with gastrointestinal bleeding. Methods A total of 163 patients treated for SAP from January 2008 to March 2012 were selected and divided into bleeding group （19 cases complicated with gastrointestinal bleeding） and control group （144 cases without gastrointestinal bleeding）. A retrospective study was carried out on the clinical data for clinical fea- tures of SAP. Results Gastrointestinal bleeding occurred in 19 cases, accounting for 11.66%. Bleeding group showed significant difference from control group on APACHEII score（48 h）, Ranson score,CT severity index,PAO2 ,PH of arterial blood, shock, severe systemic infection, MODS/MODF, ALI/ARDS, renal inadequacy, mechanical ventilation time, heparin- ize continuous vein- vein hemodiafihration time, PLT and mortality（ P 〈 0.05 ） , and no difference on age, gender, BMI, TBIL, DBIL, ALT, AST, PT, AVIT and the use of hormones （ P 〉 0.05）. Conclusions Gastrointestinal bleeding is associ- ated with the severity of severe acute pancreatitis, which usually demonstrates a variety of complications and is related with mechanical ventilation time and heparinize continuous vein -vein hemodiafihration time during treatment.