重症急性胰腺炎器官损害的临床特征及治疗  

Clinical Characteristics and Treatment of Organ Impairment of Severe Acute Pancreatitis

作　　者：高伟[1] 崔乃强[2] 

机构地区：[1]天津医科大学研究生院,天津300700 [2]天津市南开医院胆胰疾病诊疗中心,天津300100

出　　处：《中国实验方剂学杂志》2011年第10期253-256,共4页Chinese Journal of Experimental Traditional Medical Formulae

摘　　要：目的:回顾性分析2004年1月-2009年12月该院普外科收的的219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SAP自然病程中器官功能损害的病变规律及中西医结合防治经验。方法:所有SAP患者接受中西医结合治疗,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(1,3,7,10,14 d)里各器官功能障碍的发生情况,统计SAP自然病程中各器官功能障碍的发生率。结果:本组219例中,SAP累及胰外器官损害发生率从高到低顺序为肺、循环、肾、心、凝血、脑、肝、代谢。严重并发急性呼吸窘迫综合征(ARDS)46例(21%),肾衰竭23例(10.5%),休克17例(7.7%),凝血功能异常12例(5.5%),消化道出血10例(4.6%),急性肝功能衰竭3例(1.4%),胰腺脑病2例(0.9%)。经中西医结合治疗,全组病例存活190例,死亡29例,病死率13.2%。结论:重症急性胰腺炎MODS器官损害的特征为肺、肾、循环最常受累,其中与死亡密切相关的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：The case data of 219 patients with Sap complicated with multiple organ dysfunction syndrome（MODS）admitted to general surgery department were retrospectively analyzed,to summarize the pattern of pathological changes and experience of prevention and integrated Chinese and Western medicine treatment in early organ function impairment of severe acute pancreatitis（SAP）.Method： All patients with SAP received integrated Chinese and Western medicine treatment.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 of SAP were recorded and analyzed.Result： In all the 219 cases,from high to low order,the incidence of organ impairment was that of the lung,circulation,kidney,heart,coagulation,brain,liver,metabolism.Severe conplications included acute respiratory distress syndrome in 46 cases（21%）,renal failure in 23 cases（10.5%）,shock in 17 cases（7.7%）,coagulation disorder in 12cases（5.5%）,gastrointestinal bleeding in 10cases（4.6%）,liver damage in 3 cases（1.4%）,and pancreatic encephalopathy in 2 cases（0.9%）.After integrated Chinese and western medicine treatment,In the whole group,190 cases survived and 29 cases died,and the mortality was 13.2%.Conclusion：The organ impairment SAP characterized as that of the lung,kindey,circulation.Death had a close relation with acute respiratory distress syndrome,acute renal failing and shock.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 自然病程 防治 

分 类 号：R287[医药卫生—中药学]