重症急性胰腺炎42例临床分析

Clinical Analysis of Severe Acute Pancreatitis:A Report of 42 Cases

目的 :对重症急性胰腺炎 (SAP)患者的主要临床特征进行回顾性分析 ,以提高对该病诊治的认识。方法 :分析 4 2例重症急性胰腺炎患者的一般资料、临床表现、突出生化指标、影像改变、并发症及综合治疗情况。结果 :本组患者平均年龄为 (5 0 .2± 1 8.6 )岁。多以腹痛 (97.6 % )、恶心 (88.1 % )、呕吐 (88.1 % )、发热 (5 7.1 % )、腹胀(5 4 .8% )起病 ,2例 (4 .8% )出现神志改变、1例 (2 .4 % )出现腹泻。多数患者血、尿淀粉酶和血白细胞明显升高 ,血清丙氨酸转氨酶 (ALT)、血肌酐 (Cr)呈轻至中度升高 ,而血清钙则有不同程度的降低。 39例行CT检查胰腺形态学改变 1 0 0 % (39 39)。并发症多累及肝、肾、肺、心。死亡 6例 (1 4 .3% )均与多脏器功能障碍综合征 (MODS)有关。善得定、乌司他丁治疗显示一定疗效。结论 :重症急性胰腺炎多发生于中老年 ,血钙下降、腹部CT检查有助于判定预后 ,综合治疗具有重要意义。

Objective:Major clinical features and treatment of severe acute pancreatitis(SAP)were reviewed in order to improve diagnosis and treatment of the disease.Methods:The general conditions,clinical manifestation,biochemical,image changes,complication,and comprehensively therapy were assessed in 42 patients.Results:The mean age was(50.2±18.6) years.Abdominal pain(97.6%),nausea(88.1%),vomiting(88.1%),fever(57.1%),abdominal distension(54.8%)were the most common symptoms. Two patients(4.8%)showed alternate of consciousness and one(2.4%)had diarrhea.The levels of serum and urine amylases were obviously high and leukocytosis occurred in most patients.ALT and Cr levels were mildly or moderately elevated.Most patients had hypocalcemia.All 39 patients(100%)who received the scan of CT presented a positive finding.Systemic complications occurred frequently in liver,kidney,lung, and heart.All died 6 cases experienced MODS.Somatostatin and ulinastatin showed therapeutic efficacy in the patients.Conclusion:Severe acute pancreatitis most frequently affects middle age and old persons.Hypocalcemia and abdominal CT can help to determine the prognosis.Comprehensive therapy is important in SAP.