腹腔穿刺引流时机对中度重症急性胰腺炎预后的影响

Effect of Timing of Abdominal Paracentesis Drainage on Prognosis of Moderate Severe Acute Pancreatitis

目的评估不同腹腔穿刺引流(APD)时机对中度重症胰腺炎伴腹水患者预后转归的影响。方法以2019年9月-2021年5月安徽医科大学附属安庆医院收治的84例中度重症胰腺炎患者作为研究对象。根据患者入院1周内是否行腹腔穿刺引流术将其分为APD组(56例)和非APD组(28例),另外将APD组依据穿刺时间分为0~3天内APD组和4~7天内APD组,比较三组患者住院时间、住院费用、炎症指标(CRP、WBC、PCT、IL-6、TNF-α)、器官衰竭程度、进阶率及死亡率。结果0~3天内APD组患者病死率为0,进阶率为7.1%,低于4~7天内APD组的3.58%、32.14%及非APD组的17.86%、35.71%,差异有统计学意义(P<0.05);0~3天内APD组器官的衰竭程度优于4~7天内APD组和非APD组,差异有统计学意义(P<0.05);0~3天内APD组WBC、CRP、PCT、IL-6、TNF-α降低优于4~7天内APD组和非APD组,差异有统计学意义(P<0.05);0~3天APD组住院时间、住院费用低于4~7天内APD组和非APD组,差异有统计学意义(P<0.05)。结论对于明显伴有腹腔积液的中度重症胰腺炎患者,早期最佳的腹腔穿刺引流时间窗为0~3天内,该法可改善中度重症胰腺炎患者的预后,降低其炎症水平,提高其生存率。

Objective To evaluate the effect of different timing of abdominal paracentesis drainage(APD)on the prognosis of patients with moderate severe pancreatitis with ascites.Methods Eighty-four patients with moderate severe pancreatitis admitted to Anqing Affiliated Hospital,Anhui Medical University from September 2019 to May 2021 were divided into APD group(56 cases)and non-APD group(28 cases)according to whether abdominal puncture drainage was performed within one week of admission.In addition,APD group was divided into APD group within 0-3 days and APD group within 4-7 days according to puncture time.The hospitalization time,hospitalization expenses,inflammatory indexes(CRP,WBC,PCT,IL-6,TNF-α),organ failure degree,progression rate and mortality rate of the three groups were compared.Results The mortality rate of patients in the APD group within 0-3 days was 0,and the progressive rate was 7.1%,which was lower than 3.58% and 32.14% in the APD group within 4-7 days and 17.86% and 35.71%in the non-APD group,and the difference was statistically significant(P<0.05).The organ failure degree of APD group within 0-3 days was better than that of APD group within 4-7 days and non-APD group,and the difference was statistically significant(P<0.05).The decrease of WBC,CRP,PCT,IL-6 and TNF-α in APD group within 0-3 days was better than that in APD group within 4-7 days and non-APD group,and the difference was statistically significant(P<0.05).The hospitalization time and hospitalization expenses of APD group within 0-3 days were lower than those of APD group within 4-7 days and non-APD group,and the difference was statistically significant(P<0.05).Conclusion For patients with moderate severe pancreatitis significantly associated with peritoneal effusion,the early optimal peritoneal puncture drainage time window is within 0-3 days.This method can improve the prognosis of patients with moderate severe pancreatitis,reduce the inflammatory level and improve the survival rate.