危重病患者高淀粉酶血症临床研究  

CLINICAL STUDY ON HYPERAMYLASEMIA IN CRITICAL PATIENTS

作　　者：王日兴[1] 符爱玉 曾琦[1] 

机构地区：[1]海南省农垦总医院急诊科,海口570311

出　　处：《现代预防医学》2011年第18期3820-3821,3825,共3页Modern Preventive Medicine

摘　　要：[目的]探讨危重病患者高淀粉酶血症的鉴别诊断方法及临床意义。[方法]621例危重病伴高淀粉酶血症患者(APACHEⅡ评分﹥20分),观察入院后血淀粉酶的动态演变,根据血淀粉酶有无动态演变,分为无动态演变组(A组)125例,动态演变组(B组)496例,动态演变组再根据血淀粉酶升高有无大于3倍,分为两组:小于3倍组(B1组)438例与大于3倍组(B2组)58例,所有患者均进行B超或CT检査。[结果]A组B超或CT显示胰腺炎改变2例(1.60%),B1组B超或CT显示胰腺炎改变42例(9.59%),B2组B超或CT显示胰腺炎改变54例(93.10%),A组与B组,B1组与B2组之间差异均有统计学意义(P﹤0.05)。[结论]危重病高淀粉酶血症血淀粉酶升高有无动态演变、血淀粉酶升高动态演变是否大于3倍有重要的鉴别意义,无动态演变提示慢性非胰源性血淀粉酶升高,动态演变未伴血淀粉酶升高大于3倍提示胰腺损伤,动态演变伴血淀粉酶升高大于3倍提示急性胰腺炎。[Objective]To discuss the differential diagnosis and clinical significance of hyperamylasemia in critical patients.[Methods]To observe the dynamic evolution of serum amylase in 621 critical patients with hyperamylasemia after admission.All patients were divided into two groups according to their dynamic evolution of serum amylase,no dynamic evolution group（group A,n=125）and dynamic evolution group（group B,n=496）.Group B were further divided into two groups according to their serum amylase levels：elevated less than threefold group（group B1,n=438）and elevated more than threefold group（group B2,n=58）.All patients were conducted by B-ultrasound or CT examination of pancreas.[Results]In group A,group B1 and group B2,Marked by acute pancreatitis on B-ultrasound or CT examination of pancreas were 2 cases（1.60%）,42 cases（9.59%）ans 54 cases（93.10%）,respectively.There were significant difference（P﹤0.05）between group A and group B,as well as group B1 and group B2.[Condusion]Hyperamylasemia in critical patients accompanied by dynamic evolution or dynamic evolution accompanied by serum amylase elevating more than threefold had great differential value,no dynamic evolution suggest chronic extrapancreatic hyperamylasemia,dynamic evolution but serum amylase elevated less than threefold suggest pancreas injury,dynamic evolution but serum amylase elevated more than threefold suggest acute pancreatitis.

关 键 词：危重病 高淀粉酶血症 鉴别诊断 

分 类 号：R576[医药卫生—消化系统]