妊娠晚期合并高脂血症性重症急性胰腺炎14例临床分析

A Clinical Study of 14 Patients with Hyperlipidemia Severe acute Pancreatitis During Late Pregnancy

目的探讨妊娠晚期合并高脂血症性重症急性胰腺炎（severe acute pancreatitis,SAP）的临床特点和诊治要点。方法对我院1996年9月—2013年9月收治的妊娠晚期合并高脂血症性SAP 14例的临床资料进行回顾性分析。结果本组发病孕周28-34周5例,34-37周7例,37-39周2例;初产妇11例,经产妇3例;均经血脂、血尿淀粉酶、超声及CT检查明确诊断妊娠晚期合并高脂血症性SAP,其中2例首诊误诊为急性阑尾炎,3例因阴道出血疑诊胎盘早剥。14例均行剖宫产术,术后康复出院11例,死亡3例;新生儿死亡3例。结论妊娠晚期合并高脂血症性SAP病情凶险,易致胎儿宫内窘迫,产前控制血脂和早期确诊是获得良好母婴结局的关键。

Objective To discuss the clinical characteristics and the key points of diagnosis and treatment of late pregnancy merged with hypertriglyceridemia-induced severe acute pancreatitis（SPA）. Methods Retrospective analysis on the clinical data of 14 cases of late pregnant women with hyperlipidemia and severe acute pancreatitis was conducted. The patients were admitted to our hospital for treatment during September 1996 and September 2013. Results The onset in the group was at the gestational age of 28 to 34 weeks（5 cases）,34 to 37 weeks（7 cases）,37 to 39 weeks（2 cases） respectively. There were 11 cases of unipara and 3 cases of multipara in all the cases,whose diagnoses were confirmed as hypertriglyceridemia-induced severe acute pancreatitis following examinations of lipid,blood in the urine amylase,ultrasound and CT.All the patients underwent caesarean section. Among them,2 cases were first diagnosed as acute appendicitis and 3 cases with vaginal bleeding as suspected placental abruption. Of the 14 cases,there were 11 cases of postoperative rehabilitation and hospital discharge,3 cases of death and 3 cases of neonatal death. Conclusion Late pregnancy merged with hyperlipidemia and severe acute pancreatitis is a dangerous state of illness,prone to cause fetal distress. Prenatal control of blood lipid and early diagnosis are essential for the well-being of both the mother and child.