老年重症急性胰腺炎的病因及严重程度的早期评估

Etiology and Severity Evaluation of Severe Acute Pancreatitis in Elderly Patients

目的:探讨老年重症急性胰腺炎(SAP)患者的病因构成及相关临床特点,并利用四种评分方法对其严重程度进行早期评估。方法:回顾性分析我院2000年1月-2015年12月56例SAP,收集所有年龄≥60岁的27例作为老年组,并随机选取同期29例年龄<60岁的病例作为非老年组(对照组),分别观察其病因构成及相关临床特点,根据不同评分标准评估其病情的严重程度。结果:老年组病因以胆源性和酒精性为主,而对照组以胆源性和高脂血症性为主。老年组合并高血压、冠心病、脑梗死、胆总管结石、胆结石的病例多于非老年组;而非老年组合并妊娠、高血脂的病例多于老年组。老年组急性生理学与慢性健康评价Ⅱ(APACHEⅡ)、Ranson、严重程度床边指数三种评分(BISAP)均明显高于非老年组(P<0.05),但CT严重指数评分(CTSI)两组间差异无统计学意义(P>0.05)。老年组更易发生重要器官功能障碍,但是胰腺局部并发症与非老年组相似。老年组死亡风险高于非老年组(P<0.05)。结论:老年SAP病因以胆源性为主,全身并发症发生率和死亡风险高于非老年组,而局部并发症发生与非老年组无明显差异。

Objective：To investigate the etiology and clinical characteristics of severe acute pancreatitis（SAP）in elderly patients,and evaluate clinical severity by four scoring systems.Methods：In total,56 patients with SAP admitted to our hospital during January 2000 and December 2015 were retrospectively analyzed,27 cases aged 60 years or more as elderly group and another 29 cases aged less than 60 years as non-elderly group.The etiology,clinical features and illness scores based on some standard criteria were assessed.Results：The etiology of SAP in the elderly is quite different from that in the non-elderly.Biliary and alcoholic factors are main causes in the aged.Biliary and hyperlipemia are main causes in non-elderly group.Hypertension,coronary heart disease,brain infarction,choledochus stone and gallstone were more complicated in elderly group than that in non-elderly group.Pregnancy,hyperlipemia were more complicated in non-elderly group than that in elderly group.Scores of the acute physiology and chronic health evaluationⅡ（APACHEⅡ）,Ranson criteria and the bedside index for severity in acute pancreatitis（BISAP）were all higher in elderly group than those in non-elderly group（P〈0.05）.There was no statistically significant difference in scores of computed tomography severity index（CTSI）between elderly group and non-elderly group（P〉0.05）.The elderly were subject to major organ failures but there was no difference in the occurrence of local pancreatic complications between the elderly and the non-elderly group.Occurrence of risks for death is higher in elderly group than that in non-elderly group.Conclusion：Biliary factors are main causes in the aged.Occurrence of systemic complications and risks for death are higher in elderly group than those in non-elderly group,and there was no statistically significant difference in local complications between the two group.