重症急性胰腺炎早期器官损害的特征及防治  

Characteristics and Treatment of Organ Impairment in Early Stage of Severe Acute Pancreatitis

作　　者：傅强[1] 崔乃强[2] 

机构地区：[1]天津市南开医院外科重症监护病房,天津300100 [2]天津市南开医院胆胰疾病诊疗中心,天津300100

出　　处：《中国中西医结合外科杂志》2010年第2期151-154,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：国家科技支撑计划项目(2006BAI04A15)

摘　　要：目的:回顾性分析2007—2009年我院外科重症监护病房(SICU)收治的病历资料完整的58例重症急性胰腺炎(SAP)并发多器官功能障碍综合征(MODS)病例,总结早期器官功能损害的病变规律及防治经验。方法:所有SAP病人均在我院SICU接受多学科协作中西医结合综合治疗,患者入科后即给予相关监测,按其MODS标准诊断程序,记录入科后不同的时间段(1、3、7、10和14d)里各器官功能障碍的发生情况,统计SAP早期各器官功能障碍的发生率。结果:本组58例中,胃肠道普遍受累(100%),消化道外累及器官损害发生率从高到低顺序为:肺、心、代谢、肾、循环、肝、凝血、脑。严重并发症急性呼吸窘迫综合征20例(34.48%),休克13例(22.41%),肝功损害11例(18.97%),消化道出血10例(17.24%),肾衰竭6例(15.51%),凝血功能异常6例(10.34%),胰腺脑病5例(8.62%),发生时间无明显差异,全组病例14d内死亡8例,病死率13.79%,与死亡密切相关的危险因素为急性呼吸窘迫综合征、急性肾衰竭和休克。结论:重症急性胰腺炎早期MODS器官损害的特征为肺、心、代谢、肾、循环最常受累,其中与死亡密切相关的危险因素为急性呼吸窘迫综合征、急性肾衰竭和休克,中西医结合防治SAP所致多器官功能衰竭疗效显著。Objective To summarize the pattern of pathological changes and experience of prevention and treatment in early organ function impairment of severe acute pancreatitis（SAP）.Methods The case data of 58 patients with Sap complicated with multiple organ dysfunction syndrome（MODS） admitted to the surgical intensive care uniot（SICU） were retrospectively analyzed.All patients with SAP received integrated Chinese and Western medicine treatment of multi-disciplinary collaboration.After enrollment,the patients were given monitoring immediately.Based on the diagnostic procedures in accordance with MODS standard,the incidence of organ dysfunction at different time periods（1,3,7,10 and 14 days） were recorded and the incidence of organ dysfunction in the early stage of SAP were recorded and analyzed.Results In all the 58 cases,gastrointestinal tract was all involved in（100%）,and from high to low order,the incidence of extra-gastrointestinal tract organ impairment was that of the lung,heart,metabolism,kidney,circulation,liver,coagulation,and brain.Severe complications included acute respiratory distress syndrome in 20 cases（34.48%）,shock in 13 cases（22.41%）,liver damage in 11 cases（18.97%）,gastrointestinal bleeding in 10 cases（17.24%）,renal failure in 6 cases（15.51%）,coagulation disorder in 6 cases（10.34%）,and pancreatic encephalopathy in 5 cases（8.62%）.There was no significant difference among the time of occurrence.In the whole group,8 cases died within 14 days,and the mortality was 13.79%.Death had a close relation with acute respiratory distress syndrome,acute renal failure and shock.Conclusion The organ impairment in the early stage of SAP characterized as that of the lung,heart,metabolism,kidney and circulation.The prevention and treatment of multiple organ failure caused by SAP with integrated Chinese and Western medicine would be satisfactory effective.

关 键 词：重症急性胰腺炎 多器官功能障碍综合征 中西医结合 防治 

分 类 号：R657.51[医药卫生—外科学] R631[医药卫生—临床医学]