重症急性胰腺炎胃排空障碍特征分析及救治模式探讨

Investigation of the disease characteristics and treatment mode of gastric emptying disorder in severe acute pancreatitis

目的:探讨单中心重症急性胰腺炎(SAP)患者的胃排空障碍特征及救治模式,为临床救治提供参考。方法:回顾性分析2018-01—2018-12期间我院ICU收治的SAP患者34例,分析患者改良Balthazar CT评分、APACHEⅡ评分、腹腔内压、发病至出现胃排空障碍时间、胃排空障碍持续时间、开始空肠营养时间、经胃营养时间等资料。结果:男性患者24例(70.59%),平均43岁。胰腺坏死程度重和胰周多发积液(91.18%),腹腔内压升高,发病后均会导致不同程度的胃肠损伤,以Ⅱ、Ⅲ级较为常见。15例(44.12%)患者在病程7 d内开始实施空肠营养,6例(17.65%)患者在病程14 d内开始实施空肠营养;仅13例(38.24%)患者在病程<14 d过渡为经胃营养,主要与胃肠损害程度及胃肠功能障碍非一致性有关。13例(38.24%)患者在病程中出现胃液增多(≥800 ml/d),其中10例患者胃动力存在反复性;9例患者经分级治疗后5 d内恢复胃动力,选择分级治疗Ⅰ～Ⅲ级;4例患者胃液增多≥800 ml/d持续时间>5 d,诊断胃排空障碍,选择分级治疗Ⅰ～Ⅴ级。结论:SAP出现胃排空障碍与肠功能并非一致性,其临床特点存在多样性。分级治疗模式能取得良好效果,可供临床借鉴。

Objective:To investigate the treatment mode of gastric emptying disorder in severe acute pancreatitis.Method:Retrospective analysis of clinical data of severe acute pancreatitis in our ICU during 2018.The modified Balthazar CT score,APACHEⅡscore,IAH,appear gastric empty obstacle time,duration of gastric emptying disorder,start jejunal nutrition time,time for gastric nutrition.Result:Of the 34 patients,the mean age was 43 years,and 70.59%were male.The severe pancreatic necrosis and multiple hydrops were found around the pancreas(91.18%),intraperitoneal pressure increased,all can lead to different degrees of gastrointestinal injury,withⅡ,Ⅲis common.Jejunal nutrition was started in 15 patients(44.12%)within 7 days of disease course,and jejunal nutrition was started in 6 patients(17.65%)within 14 days of disease course;Only 13 patients(38.24%)began to have gastric nutrition at the course<14 d,mainly due to the degree of gastrointestinal damage and gastrointestinal dysfunction inconsistency.In13 patients(38.24%),gastric juice increased during the course of the disease(≥800 ml/d),among which 10 patients had recurrent gastric motility.9 patients,through grading within 5 days after treatment to restore the stomach power,choose classⅠ-Ⅲtreatment;Four patients increased gastric juice≥800 ml/d or duration>5 d,diagnosis of gastric emptying disorder,select classⅠ-Ⅴtreatment.Conclusion:The gastric emptying disorder in SAP is not consistent with intestinal function,and its clinical characteristics are diverse.The graded treatment model can achieve good results and can be used for clinical reference.