早期通便、引流治疗重症急性胰腺炎腹腔高压的效果观察

Clinical effect of early bowel-relaxing treatment and drainage in treatment of severe acute pancreatitis with intra-abdominal hypertension

目的探讨早期通便、引流对重症急性胰腺炎(SAP)治疗的效果。方法回顾性分析株洲市中心医院肝胆胰外科2009年1月-2015年1月收治的52例SAP患者的临床资料,分为常规治疗组(22例)和通便引流组(30例)。比较两组2周内多器官功能不全综合征及腹腔间隔室综合征发生率、腹内压降至15 cm H2O以下时间、胃肠功能恢复时间、胰腺感染率和病死率的差异。两组间计量资料比较采用独立样本t检验;计数资料比较采用χ2检验。结果与常规治疗组相比,早期通便引流组患者2周内多器官功能不全综合征及腹腔间隔室综合征发生率显著降低(31.8%vs 10.0%,22.7%vs 3.3%,χ2值分别为3.89、4.68,P值分别为0.049、0.031),胰腺感染率及病死率显著下降(40.9%vs 13.3%,22.7%vs 3.3%,χ2值分别为5.15、4.68,P值分别为0.023、0.031)。与常规治疗组相比,早期通便引流组患者腹内压降至15 cm H2O以下时间[(4.7±1.0)d vs(8.3±0.9)d]、肠鸣音[(3.0±0.5)d vs(6.5±0.9)d]及排气排便恢复时间[(3.8±0.7)d vs(7.8±0.9)d]明显缩短,差异均有统计学意义(t值分别为1.02、6.67、2.13,P值均<0.01)。结论 SAP早期采取通便、引流可有效降低腹腔高压的程度,保护重要脏器功能,一定程度缓解SAP的病情,减少并发症的出现,从而显著改善SAP的预后。

Objective To investigate the clinical effect of early bowel -relaxing treatment and drainage in the treatment of severe acute pan-creatitis （SAP）.Methods A retrospective analysis was performed for the clinical data of 52 patients with SAP who were admitted to De-partment of Hepatopancreatobiliary Surgery,Zhuzhou Central Hospital,from January 2009 to January 2015,and these patients were divided into conventional treatment group with 22 patients and early bowel -relaxing/drainage group with 30 patients.The incidence of multiple or-gan dysfunction syndrome and abdominal compartment syndrome within 2 weeks,time to intra -abdominal pressure reduced to below 15 cm H2 O,time to gastrointestinal function recovery,pancreatic infection rate,and mortality rate were compared between the two groups.The in-dependent samples t -test was used for comparison of continuous data between the two groups,and the chi -square test was used for compar-ison of categorical data.Results Compared with the conventional treatment group,the early bowel -relaxing/drainage group had significant reductions in the incidence rates of multiple organ dysfunction syndrome （31.8% vs 10.0%,χ2 =3.89,P =0.049）and abdominal com-partment syndrome （22.7% vs 3.3%,χ2 =4.68,P =0.031）within 2 weeks,pancreatic infection rate （40.9% vs 13.3%,χ2 =5.15,P=0.023）,and mortality rate （22.7% vs 3.3%,χ2 =4.68,P =0.031）.Compared with the conventional treatment group,the early bowel-relaxing/drainage group had significantly shortened time to intra -abdominal pressure reduced to below 15 cm H2 O,time to bowel sound recovery,and time to the recovery of passing of flatus and defecation （t =1.02,6.67,and 2.13,all P 〈0.01）.Conclusion In the early stage of SAP,bowel -relaxing treatment and drainage can effectively reduce intra -abdominal hypertension,protect vital organ function,al-leviate the condition of SAP,reduce the incidence of complications,and thus significantly improve the prognosis of SAP.