老年重症急性胰腺炎56例临床分析

Clinical Analysis on 56 Cases of Elderly Patients with Severe Acute Pancreatitis

目的探讨老年重症急性胰腺炎(SAP)的发病特点及治疗策略。方法回顾性分析2005年12月至2012年12月天津市武清区人民医院收治的56例老年SAP患者(老年组)的临床资料,并与同期81例非老年SAP患者(非老年组)的病因、临床表现、并存疾病、并发症及病死率等资料进行对比研究。结果老年SAP最常见病因为胆源性,多伴其他慢性疾病,老年患者腹痛和发热的发生率分别为55.36%和64.29%,均低于非老年组的83.95%和86.42%(P<0.01);老年患者的多器官功能障碍及休克发生率分别为39.29%和32.14%,显著高于非老年组的6.17%和13.58%(P<0.01),而局部并发症与非老年组无明显差异;老年患者平均住院(25.2±13.4)d,较非老年组(16.1±7.3)d明显延长(P<0.01),病死率14.29%高于非老年组的1.32%(P<0.05)。结论老年SAP以胆源性胰腺炎为主,临床症状无特异性,伴发疾病多,多器官功能障碍发生率较高。治疗上遵循多学科参与,以非手术治疗为主的综合治疗体系,在适时、适当的时候进行外科干预。

Objective To investigate the clinical characteristics and therapeutic strategy of senile severe acute pancreatitis （SAP）. Methods A total of 56 cases of elderly patients with SAP admitted in Wuqing People＇s Hospital from Dec. 2005 to Dec. 2012 were selected as the elderly group,another 81 cases of nonelderly patients with SAP admitted in the hospital during the same period were selected as the non-elderly group. The clinical data of patients in the two groups were retrospectively analyzed, and the etiology, clinical characteristics,coexisting diseases, local complications and systemic complications, as well as the mortality rates of the two groups were compared. Results The most common causes of SAP in elderly patients were biliary etiologies, and many of the cases were associated with other chronic diseases. In the elderly group, the incidence rates of abdominal pain and fever were 55.36% and 64.29% ,lower than 83.95% and 86.42% of non-elderly group （P 〈 0.01 ） ;incidence rates of multiple organ dysfunction syndrome （MODS） and shock of the elderly group were 39.29% and 32.14%, significantly higher than 6.17% and 13.58% of non-elder- ly group（ P 〈 0.01 ）, while there were no statistically significant differences of the local complications betweenthe two groups. The average hospital stay of the elderly group was （25.2 ± 13.4） days,significantly longer than （ 16.1 ±7.3 ） days of non-elderly group（ P 〈 0.01 ） ; and the mortality of the elderly group was 14.29% ,higher than 1.32% of non-elderly group（ P 〈 0.05 ）. Conclusion The most common type of SAP in elderly patients is acute biliary pancreatitis. Senile SAP has no specific clinical symptoms, but has many concomitant diseases and high incidence of MODS. Therefore, treatment for senile SAP should be based on the multi-disciplinary, comprehensive treatment system which mainly includes the non-surgical therapy with limited surgical intervention in appropriate timing.