13例重症急性胰腺炎诊治特点临床分析

Analysis on clinical characteristics of diagnosis and treatment of 13 severe acute pancreatitis

目的探讨重症急性胰腺炎诊治特点。方法回顾性分析13例重症急性胰腺炎患者临床资料,包括一般资料、生化检测及影像资料、治疗措施与预后结果,纳入标准为急性胰腺炎合并器官衰竭>48 h(改良Marshall评分≥2分)。结果重症急性胰腺炎患者一般资料中普遍突出存在心率增快(121.07±28.09)次/分、APACHE II评分偏高(18.92±7.34),病因排序则是高脂血症(38.5%)>胆石症(30.8%)>酒精性(23.1%),SAP合并ARDS发生率可达46.2%,合并AKI则高达69.2%;WBC(12.60±5.57)×109/L、CRP(138.16±67.06)mg/L及PCT(15.76±27.33)ng/L等炎症指标升高提示SAP普遍存在炎症反应,影像学中69.2%患者合并发生肺炎及腹腔积液则提示多处感染部位,其他脏器指标异常升高也提示SAP患者心肺肝肾均存在不同程度的受损;接受CRRT治疗及呼吸支持可分别达46.2%及76.9%,7天内死亡例数为1例(7.7%),28天内死亡例数为4例(30.8%),ICU及总住院时间为(10.77±7.38)及(19.61±13.40)天。结论重症急性胰腺炎是全身及局部性的炎症反应累及全身各个脏器的急性复杂病变,以合并发生ARDS及AKI为临床特征,需要多器官功能保护与替代、外科干预等多学科综合协作治疗。

Objective To evaluate characteristics of diagnosis and treatment on severe acute pancreatitis. Methods To respective analysis clinical data of 13 patients with severe acute pancreatitis. The data included baseline characteristics,biochemical tests and imaging data,treatment and prognosis,inclusion criteria for acute pancreatitis with organ failure 48 h（ modified Marshall score 2）. Results Higher heart rate（ 121. 07 ± 28. 09） times/min and APACHEII scores（ 18. 92 ±7. 34） were universally found in SAP,which primary disease contained hyperlipidemia（ 38. 5%） cholelith disease（ 30. 8%） alcohol（ 23. 1%） with incidence of ARDS and AKI being 46. 2% and 69. 2%; Higher inflammatory biomarkers including WBC（ 12. 60 ± 5. 57） × 10^9/ L,CRP（ 138. 16 ± 67. 06） mg / L and PCT（ 15. 76 ± 27. 33） ng / L indicated widespread inflammation with many infection sites revealing by 69. 2% pneumonia and peritoneal effusion on imaging; Other abnormally biochemical index prompted some injury of viscera including heart,lungs,kidney and liver; 1 case suffered death within 7 days and4 cases also did within 28 days,ICU and total length of hospital stay was（ 10. 77 ± 7. 38） and（ 19. 61 ± 13. 40） days,CRRT treatment and respiratory support respectively reached 46. 2% and 46. 2%. Conclusion Severe acute pancreatitis is a acute complex pathological changes on various organs induced by acute systemic and local inflammation with feature of mergence with the ARDS and AKI,which need the multidisciplinary integrated collaborative treatment on organ function protection and sustain and surgical intervention.