重症急性胰腺炎死亡原因和治疗探讨

Causes of Death in Patients with Severe Acute Pancreatitis and the Corresponding Treatment.

目的:探讨重症急性胰腺炎(SAP)死亡原因和治疗对策。方法:对我院1991年1月～2002年12月收治的SAP病例进行回顾性分析研究。结果:死亡20例,年龄>60岁13例(65％)。15例(76％)死于多脏器功能障碍综合征(MODS),2例因伴随疾病加重分别死于心功能衰竭和呼吸衰竭,1例死于应激性溃疡,1例死于DIC,1例死于术后腹腔内出血。结论:重视老年患者,积极治疗伴随疾病;加强重症监护治疗;严格掌握手术指征,选择正确的手术时机;积极预防、严密监测并及时、准确地诊断胰腺感染性坏死。

Objective: To investigate causes of death in patients with severe acute pancreatitis (SAP) and the corresponding treatment.Methods: SAP cases admitted during the past 12 years were reviewed retrospectively. Results: There were twenty deaths including thirteen (65%) elderly patients over 60 years old. Fifteen (76%) died of multiple organ dysfunction (MODS). Two patients died of cardiac failure or respiratory failure respectively, as a result of exacerbation of their pre - exist-ing co - morbid conditions. Two deaths were due to stress ulcer or DIC respectively. One death was related to postoperative in-tra - abdominal massive bleeding. Conclusion: Elderly SAP patients should be emphasized to improve their pre - existing co -morbid conditions. Intensive care treatment should be developed. Operative indication and timing for SAP should be considered deliberately. Pancreatic infected necrosis should be prevented, supervised or diagnosed effectively.