早期腹腔穿刺引流治疗重症急性胰腺炎  

Effects of early peritoneal puncture and catheter drainage on severe acute pancreatitis

作　　者：詹苏东[1] 彭涛[1] 陶京[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科中心,武汉430022

出　　处：《中华普通外科杂志》2012年第9期717-720,共4页Chinese Journal of General Surgery

摘　　要：目的探讨重症急性胰腺炎并腹腔高压早期行腹腔穿刺置管引流对脏器功能障碍的治疗作用。方法回顾性研究武汉协和医院胰腺外科中心2001年1月至2010年9月确诊的重症急性胰腺炎并腹腔高压患者405例，将患者分为两组，发病早期未行腹腔穿刺引流减压组，共137例，发病早期行腹腔穿刺引流减压组，共268例。结果穿刺组患者与未穿刺组患者膀胱压，APACHEII评分差异有统计学意义（P〈0．05）。穿刺组患者急性呼吸窘迫综合征，急性肾功能衰竭和多器官功能障碍综合征发生率明显低于未穿刺组患者（分别为14％比27％、21％比32％、9％比14％，均P〈0．05），两组患者早期开腹减压手术率和早期死亡率差异有统计学意义（分别为4％比12％，3％比6％，均P〈0．05），但两组患者负平衡出现时间差异无统计学意义[（5．9±2．9）d比（5．9±2．4）d，P〉0．05]。结论早期腹腔穿刺引流可以降低重症急性胰腺炎并腹腔高压患者的腹腔内压力，同时可以减少脏器功能衰竭的发生率和重症急性胰腺炎患者早期开腹减压手术率与早期死亡率。Objective To evaluate the effect on organ function by early peritoneal puncture and catheter drainage for intra-abdominal hypertension during the course of severe acute pancreatitis （SAP）. Methods A retrospective study was conducted on 405 patients of severe acute pancreatitis with IAH at Department of Pancreatic Surgery, Wuhan Union Hospital from January 2001 to September 2010. In the early course of SAP, 137 cases did not receive peritoneal puncture and drainage decompression, 268 cases were treated with peritoneal puncture and drainage decompression. Results The differences of the scores of UBP and APACHE 11 were statistically significant between the puncture group and the non-puncture group （P 〈 0.05）. The occurrence of ARDS, ARF and MODS in the group of puncture were significantly lower than those of the non-puncture group （14% vs. 27% ,21% vs. 32%, 9% vs. 14% , respectively,all P 〈 0. 05）. At the same time, the differences between rate of early laparotomy and rate of early mortality in the two groups were statistically significant （4% vs. 12%, 3 % vs. 6%, respectively, all P 〈 0.05 ）. However, there was no significant difference in the occurrence time of negative balance in the two groups （5. 9 ± 2. 9 vs. 5.9 ± 2. 4, P 〉 0. 05 ）. Conclusions Early abdominal puncture and drainage reduce the abdominal pressure of patients with SAP and IAH. It also reduces the occurrence of organ failure, the rate of early laparotomy and the rate of early mortality in SAP patients.

关 键 词：胰腺炎 急性坏死性 穿刺术 引流术 腹腔高压 

分 类 号：R576[医药卫生—消化系统]