儿童重症监护病房收治急性胰腺炎的临床特征与预后分析

Clinical characteristics and prognostic analysis of children with acute pancreatitis in the pediatric intensive care unit

目的了解儿童重症监护病房收治急性胰腺炎的临床特征与预后。方法回顾性总结2016年7月至2021年6月上海交通大学附属儿童医院重症医学科(PICU)收治的急性胰腺炎患儿的资料,包括病因、临床特点、影像学特点、并发症和结局。结果同期PICU收治急性胰腺炎患儿47例(男24例,女23例),发病月龄84(48,144)个月,其中轻症4例、中度重症5例和重症38例。病因以药物相关为主(23例,48.9%)。器官功能障碍主要为休克28例(59.6%)、急性呼吸衰竭21例(44.7%)、胃肠功能障碍30例(63.8%)、凝血功能障碍29例(61.7%)等,并发症包括毛细血管渗漏综合征18例(38.3%),高血糖症(>8 mmol/L)24例(51.1%)。47例患儿血淀粉酶和脂肪酶均升高,药物性胰腺炎与非药物性胰腺炎相比,血乳酸[3.0(2.1,4.5)mmol/L比1.6(1.1,3.1)mmol/L,P=0.013]和所需血管活性药物指数[15.0(0,75.0)比0(0,8.8),P=0.035]明显升高。全部患儿经治疗后病情好转成功转出PICU。结论小儿急性胰腺炎病因以药物相关性为主,主要器官功能障碍包括休克、急性呼吸衰竭、胃肠功能障碍和凝血功能异常。儿童胰腺炎预后较好。

Objective To investigate the clinical characteristics and prognosis of children with acute pancreatitis(AP)admitted to the pediatric intensive care unit(PICU).Methods The etiology,clinical data,imaging features,complications,and outcomes of children with AP admitted to PICU at Shanghai Children′s Hospital from July 2016 to June 2021 were retrospectively analyzed.Results Totally,47 patients with AP including 24 males and 23 females were enrolled.The mean age was 84(48,144)months.Four patients with mild AP,5 patients with moderately severe AP(MSAP)and 38 cases with severe AP(SAP)were diagnosed.The main etiology was drug-related pancreatitis in 23 cases(48.9%).The organ dysfunction mainly included shock in 28 cases(59.6%),acute respiratory failure in 21 cases(44.7%),gastrointestinal disorders in 30 cases(63.8%),and coagulopathy in 29 cases(61.7%).The complications included capillary leakage syndrome in 18 cases(38.3%)and hyperglycemia(>8 mmol/L)in 24 cases(51.1%).Serum amylase and lipase levels were increased in 47 cases(100%).There were significant differences in blood lactate[3.0(2.1,4.5)mmol/L vs.1.6(1.1,3.1)mmol/L,P=0.013],and the use of vasoactive drugs[15.0(0,75.0)vs.0(0,8.8),P=0.035]between drug-induced pancreatitis and non-drug-induced pancreatitis.All the patients′conditions were improved after treatment and transferred out of PICU.Conclusion The etiology of acute pancreatitis in children is mainly drug-related,and the main organ dysfunction includes shock,acute respiratory failure,gastrointestinal dysfunction and coagulation dysfunction.The prognosis of childhood pancreatitis is good.