流行性出血热合并胰腺炎患者临床表现及预后研究

Clinical manifestations and prognosis of patients with epidemic hemorrhagic fever complicated with pancreatitis

目的研究流行性出血热合并胰腺炎的临床特点及其预后。方法收集2014～2018年楚雄州人民医院流行性出血热致胰腺炎患者20例(实验组),对其症状、体征、理化检查、治疗、结果等指标进行统计分析。随机抽取该院外科胆源性胰腺炎20例(对照组)入院24 h的血淀粉酶及脂肪酶值作为对照。结果实验组20例,其中轻型12例,中型4例,危重型4例;血液净化7例,呼吸支持2例,误诊10例,治愈16例(80%),死亡2例(10%),病危自动出院2例(10%)。确诊时间0～6 d,平均2 d。误诊较常见。此病呈多器官(包括胰腺)受损表现,患者大多有发热、多尿、腹痛、上腹压痛、电解质紊乱的病史,同时具备"三痛三红"者不多。"五期"经过不全。呈间歇热。生化检查:降低的指标:血小板、白蛋白。升高的指标:肝酶、心肌酶、肾功能、血淀粉酶及脂肪酶、凝血功能、PCT、IL-6、CRP。与胆源性胰腺炎比较:血脂肪酶相对低,有显著性差异。结论流行性出血热病毒感染具有泛嗜性,损伤器官的范围不具均衡性,合并胰腺炎者脂肪酶升高不明显,但病情重,极易误诊,死亡率高。全科思维辨析是解决误诊误治的关键。

Objective To explore the clinical features and prognosis of epidemic hemorrhagic fever with pancreatitis.Methods Twenty patients(experimental group)of pancreatitis caused by epidemic hemorrhagic fever in Chuxiong People's Hospital from 2014 to 2018 were collected,and their symptoms,signs,physical and chemical examination,treatment,results and other indicators were statistically analyzed.The 24h blood amylase and lipase values of 20 patients with biliary pancreatitis(control group)were randomly selected for comparison.Results Among the 20 patients in the experimental group,which were 12 cases of mild type,4 cases of moderate type,and 4 cases of critical type;7 cases of blood purification,2 cases of respiratory support,10 cases of misdiagnosis,16 cases of cure(80%),2 cases of death(10%),and 2 cases discharged without advice(10%).The time of diagnosis:0-6 days,with an average of 2 days.Misdiagnosis was common.The disease presented with multiple organ damage(including the pancreas).Most patients had a history of fever,polyuria,abdominal pain,upper abdominal tenderness,and electrolyte imbalance,but not many people had"three pains and three reds"at the same time.The five periods were not complete.The patients had intermittent fever.Biochemical tests:The reduced indicators included platelets and albumin.The elevated indicators included liver enzymes,myocardial enzymes,renal function,blood amylase and lipase,coagulation function,PCT,IL-6,and CRP.Compared with biliary pancreatitis:the blood lipase was lower,with significant difference.Conclusion Epidemic hemorrhagic fever virus infection is ubiquitous,but the range of damaged organs is not balanced.The lipase symptom of patients with pancreatitis is not very high,but the condition is severe,which is easily misdiagnosed,and the mortality rate is high.General thinking is the key to solving misdiagnosis and mistreatment.