重症胰腺炎并发胰性脑病的临床分析

Clinical study of pancreatic encephalopathy in severe acute pancreatitis

目的 探讨重症急性胰腺炎合并胰性脑病的发病机制、诊断与鉴别诊断以及临床防治措施。方法 对 2 0 0 0年 1月～ 2 0 0 3年 6月本中心收治的 30 1例急性重症胰腺炎中的 1 4例胰性脑病病人进行回顾性研究 ,分析其临床表现、治疗经过及预后。结果 30 1例急性重症胰腺炎病人中 1 4例并发有胰性脑病 ,发生率为 4 .6 %。其中早期即SIRS期 9例 ,后期即感染期 5例。胰性脑病临床表现有烦躁不安、多语、定向能力障碍、嗜睡、狂躁、幻觉 ,甚至昏迷。神经系统检查发现有脑膜刺激征、颅内压增高以及脑脊髓并候群症以及脑脊液淀粉酶增高。晚期出现胰性脑病病人常并有深部真菌感染以及体液代谢紊乱。治疗上去除引起胰性脑病的各种诱因。SIRS期 9例中 3例死亡 ,均死于MOF ,感染期 5例中 1例死于严重感染并发MOF。其余病人症状缓解治愈出院。结论 胰性脑病是急性重症胰腺炎的少见的严重并发症 ,积极消除其各种诱因 ,有助于降低胰性脑病的发生率。早期发现 ,一旦发生胰性脑病积极给予脑复苏及神经营养支持治疗 ,对降低死亡率有重要意义。

Objective To investigate the pathogenesis, diagnosis, differential diagnosis and therapy of pancreatic encephalopathy (PE) in severe acute pancreatitis (SAP).Methods Clinical data of 14 patients with PE among 301 cases of SAP in the past 3 years were collected and the clinical manifestations, therapy and prognosis were retrospectively analyzed.Results l4 patients among 301 cases of SAP were complicated with PE ( 4.6% ). Nine cases of PE appeared in earlier period (SIRS period) and 5 cases in later period (infection period). Clinical manifestations of PE mainly included nerve system symptoms such as dysphoria, disturbance of orientation, illusion, somnolence and coma. Patients with PE also had symptoms of meningeal irritation signs, increased intracranial pressure and increased amylase in cerebrospinal fluid. PE patients in later period often had deeper eumycetes infection and disturbance of body fluid metabolism. The therapy focused on SAP and eliminated causes of PE. Four PE patients in SIRS period were dead because of multiple organ failure (MOF) and one patient had the slight disorder of consciousness after 9 month. One PE patient in infection period was dead because of severe sepsis following MOF. The remaining patients were cured.Conclusion PE is one of severe complications in SAP. Eliminating causes of PE and early diagnosis were important. Cerebral resuscitation and never nutrition therapy while final diagnosis of PE is made are helpful to decrease death rate of PE.