重症急性胰腺炎与全身炎性反应综合征的临床探讨

Clinical study on server acute pancreatitis and systemic inflammatory response syndrome

目的 加强对重症急性胰腺炎 (SAP)中全身炎性反应综合征 (SIRS)的认识。方法 回顾 1 991～ 2 0 0 0年 60例SAP住院患者SIRS的发生及其全病程 ,并对其治疗和死亡原因进行分析。结果 (1 )SAP患者 96 .7%出现SIRS ,持续时间平均 5 .6± 3 .5d。 (2 )SAP并发脓毒症后死亡率明显增高 (P <0 .0 5)。 (3)未手术组并发脓毒症、多脏器功能障碍综合征 (MODS) ,多脏器系统功能衰竭 (MSOF)及死亡率明显高于手术组 ,分别为P <0 .0 5、P <0 .0 1、P <0 .0 1、P <0 .0 5。 (4)近期手术组与延期手术组死亡率无明显差异 (P >0 .0 5)。结论 SAP一旦其SIRS的诱因未及时控制或消除 ,最终会发展为MODS。应在代谢支持的前提下 ,在抗感染的基础上 ,选择适当的手术时机 ,防止SIRS发展为MODS。

Objective To clarify conceptions about severe acute pancreatitis(SAP) and systemic inflammatory response syndrome (SIRS).Methods Sixty patients with SAP were enrolled in this study. Development of SIRS in these patients was examined and discussed in terms of course of disease and cause of death. Results SIRS occurred in 96.7% of the patients and lasted 5.6 ± 3.5 ; Death rate of the cases of SAP complicated with sepsis was significantly higher than that of the other cases ( P < 0.05 ), Incidence rate of SAP complicated with sepsis, multiple organ dysfunction syndrome (MODS), multiple system organ failure (MSOF) and death in non operative treatment group was significantly higher than those of operative treatment group ( P < 0.05 , P < 0.01 , P < 0.01 and P < 0.05 , respectively). Conclusion The course of SAP would advance into the MODS stage ultimately when inducements which facilitate the development of SIRS can not be controlled or removed effectively. Principle of treatment for SAP includes organ supporting, infection control, correction of circulator and metabolic disturbance and operative treatment at proper moments.