早期腹腔穿刺引流在重症急性胰腺炎治疗中的应用价值

Early abdominal puncture drainage in treatment of severe acute pancreatitis

目的探讨早期腹腔穿刺引流(APD)对重症急性胰腺炎(SAP)的疗效及安全性。方法回顾性分析2013年1月至2020年5月安徽医科大学第二附属医院重症医学科收治的189例SAP患者的临床资料。根据入重症监护室(ICU)后1周内是否行超声引导下APD分为APD组(n=90)和非APD组(n=99)。比较两组患者术前和术后1周的急性生理与慢性健康状况(APACHE)Ⅱ评分、改良Marshall评分、序贯器官衰竭评价(SOFA)评分等临床资料,以及腹膜后经皮穿刺置管引流率、住院时间等预后指标。结果189例SAP患者中男性110例,女性79例,年龄(52.5±17.4)岁。入ICU时,APD组血淀粉酶、C-反应蛋白、降钙素原、白细胞介素-6、APACHE II评分、改良Marshall评分、SOFA评分均高于非APD组,差异有统计学意义(P<0.05);治疗1周后,两组患者的多数临床指标均得到改善,且各指标间差异均无统计学意义(P>0.05)。APD组患者腹腔感染发生率、腹膜后经皮穿刺置管引流率、死亡率与非APD组差异无统计学意义(P>0.05)。APD组患者的住院时间[29(18,45)比21(15,32)d]、住ICU时间[5(3,11)比7(5,17)d]均高于非APD组,差异有统计学意义(P<0.05)。结论对于伴有腹腔积液的SAP患者,早期APD可有效改善病情及预后,且不增加腹腔感染发生率及死亡率。

Objective To study the efficacy and safety of early abdominal puncture drainage(APD)in severe acute pancreatitis(SAP).Methods A retrospective study was conducted on 189 patients with SAP who were managed at the Department of Intensive Medicine of the Second Affiliated Hospital of Anhui Medical University from January 2013 to May 2020.According to whether ultrasound-guided APD was performed within one week after admission to ICU,these patients were divided into 2 groups:patients treated with APD(the APD group)and patients treated without APD(the non-APD group).Clinical data,including the acute physiological and chronic health status(APACHE)Ⅱscore,modified Marshall score,sequential organ failure evaluation(SOFA)score,and prognostic indicators including the retroperitoneal percutaneous drainage(PCD)rate and length of hospital stay,were compared between the two groups before and 1 week after surgery.Results Of the 189 SAP patients in this study,there were 110 males and 79 females,aged(52.5±17.4)years old.On admission to ICU,the blood amylase,C-reactive protein,procalcalonin,interleukin-6,APACHE II score,modified Marshall score and SOFA score in the APD group were significantly higher than those in the non-APD group.After 1 week of treatment,most clinical indicators in the 2 groups were significantly improved,and there were no significant differences between these indicators(all P>0.05).There were no significant differences in the abdominal infection,retroperitoneal PCD and mortality rates between the APD group and the non-APD group(P>0.05).The length of hospital stay[29(18,45)vs 21(15,32)d]and ICU stay[5(3,11)vs.7(5,17)d]in the APD group were significantly higher than those in the non-APD group(P<0.05).Conclusion For patients with SAP with peritoneal effusion,early APD effectively improved the condition and prognosis without increasing the peritoneal infection and mortality rates.