暴发性胰腺炎早晚期死亡原因分析(英文)  

The Study on Causes of Death in Fulminant Pancreatitisat Early Stage and Late Stage

作　　者：杨晓楠[1] 郭佳[1] 林子琦[1] 黄蕾[1] 金涛[1] 吴伟[1] 文礼[1] 张肇达[2] 夏庆[1] 胡伟明[2] 

机构地区：[1]四川大学华西医院中西医结合科,成都610041 [2]四川大学华西医院普外科,成都610041

出　　处：《四川大学学报（医学版）》2011年第5期686-690,584,共5页Journal of Sichuan University(Medical Sciences)

基　　金：Supported by National Natural Science Foundation of China(No.81072910);Science and Technology Support Program ofSichuan(No.2009SZ0201,2010SZ0068)~~

摘　　要：目的探讨暴发性胰腺炎（FP）早晚期死亡原因。方法将本中心2000~2010年收治的92例FP中死亡的55例患者,按死亡时间分成早期组（7 d内死亡）和晚期组（7 d后死亡）,对其24 h急慢性生理评分Ⅱ（APACHEⅡ）,并发症及其发生时间,以及感染部位和菌群进行对比分析。结果 FP的病死率为59.8%（55/92例）,其中,20.6%（19例）3 d内死亡,29.3%（27例）14 d后死亡。早期组24 h APACHEⅡ评分及血清甘油三酯高于对照组（P〈0.05）;肾功能衰竭休克、急性肝损伤、脑病、消化道出血及感染的发生时间早于晚期组（P〈0.05）;晚期组脑病、消化道出血及胰腺坏死感染的发生率高于早期组（P〈0.05）,感染以革兰氏阴性菌为主。结论 FP主要死于早期全身炎性反应综合征及后期感染引起的多器官衰竭,感染主要以革兰氏阴性菌为主。Objective To investigate clinical characteristics of fulminant pancreatitis（FP） died at early and late stage,analyze the difference in death causes of FP at these two stage.Methods Ninety-two（92） patients with FP were admitted in our center from January 2000 to June 2010,and 55 patients of them died of FP.These dead FP patients were divided into two groups according to the death time： within 7 d（early death group） or after 7 d（late death group）.The 24 h Acute Physiology and Chronic Heath Evaluation Ⅱ（APACHE Ⅱ） score,the occurrence of complications were compared between these two groups.Results The mortality of FP was 59.8%（55/92）,in which 20.6%（19 cases） died within 3 d and 29.3%（27 cases） died after 14 d.Compared with the late death group,the early death group showed higher 24 h APACHE Ⅱ score and serum triglyceride level（P0.05）,and also had higher occurring time of renal failure,shock,hepatic failure,encephalopathy,gastrointestinal hemorrhage and infection（P0.05）.However,the incidences of encephalopathy,gastrointestinal hemorrhage and pancreatic necrosis infection in the late death group were higher than those in the early group（P0.05）.In addition,the major pathogenesis of infection was Gram-negative bacterium.Conclusion The most important and common cause of death for the patients with FP is multiple organ dysfunction syndrome,which usually was the consequence of systemic inflammation response syndrome in the early stage,and the severe infection in the later stage,respectively.

关 键 词：暴发性胰腺炎 多器官功能衰竭 感染 临床研究 

分 类 号：R576[医药卫生—消化系统]