高脂血症性急性胰腺炎死亡病例临床分析  

The clinical analysis of fatal cases with acute hyperlipidemic pancreatitis

作　　者：侯振宇[1] 张静[1] 张鸿涛[2] 顾凯凯[2] 

机构地区：[1]武警后勤学院附属医院普外科,天津300162 [2]天津市南开医院普外科

出　　处：《临床外科杂志》2012年第9期623-625,共3页Journal of Clinical Surgery

摘　　要：目的 分析高脂血症性急性胰腺炎死亡病例的临床特点,探讨与高脂血症性急性胰腺炎死亡相关的危险因素.方法 回顾性分析我们收治的86例高脂血症性急性胰腺炎患者的临床资料,根据是否死亡分为死亡组和生存组,比较两组患者的基本资料、实验室资料、Ranson评分、APACHE Ⅱ（Acute Physiology and Chronic Health Evaluation,急性生理与慢性健康）评分及CTSI（CT Severity index,CT严重指数）等方面的差异.结果 31例死亡病例中男性占67.74%,平均年龄（41.6±8.2）岁,发病至死亡平均时间（10.49±4.40）d,两组在血尿淀粉酶、甘油三酯、CT严重指数等方面差异无统计学意义（P〉0.05）;死亡组血糖较生存组明显升高（P〈0.05）,血钙明显降低（P〈0.05）.Ranson评分、APACHEⅡ评分明显高于生存组（P〈0.05）.结论 高脂血症性急性胰腺炎好发于中青年男性,死亡时间多集中在胰腺炎发病早期,死亡原因多为多器官衰竭,特别是呼吸、肾功能衰竭和代谢紊乱;胰腺本身的病变可能并不严重,不可控制的血糖和血钙可能是预示高脂血症性急性胰腺炎死亡的危险因素.Objective To investigate the clinical features of fatal cases of acute hyperlipidemic pancreatitis（HLP） and discuss the risk factors for death. Methods The clinical data of 86 patients with HLP were retrospectively analyzed. All the patients were divided into the death group and the survival group. Basic information, laboratory data, Ranson score, acute physiology and chronic health evaluation （A-PACHE） Ⅱ score and CT severity index（CTSI） were compared between the two groups. Results In all 31 fatal cases,67.74% of them were male, the average age was （47.8 ± 1.8 ）years and the average time from illness onset to death was （ 10.49 ± 4.40 ） days. There were no statistical significances between the two groups in blood amylase, urine amylase, triglyceride or CTSI. The death group showed a significant increase in serum glucose and reduction in blood calcium（ P 〈 0.05 ）. The Ranson score and APACHE Ⅱ score in the death group were higher than that in the survival group （ P 〉 0.05 ）. Conclusion HLP was more likely to happen in young and middle-aged men, the death of most patients occurred in the early stage of acute pancreatitis, and the main cause of death was multiple organ failure, especially respiratory failure, kidney failure and metabolic disturbance; The pathological changes of the pancreas may not be serious, and un- controlled serum glucose and calcium were risk factors for death in patients with HLP.

关 键 词：急性胰腺炎 高脂血症 血糖 器官衰竭 

分 类 号：R657.51[医药卫生—外科学]