22例高龄产妇并发急性胰腺炎患者的临床分析  

A clinical analysis from 22 cases pregnant women complicated with acute pancreatitis

作　　者：戚伟珍 徐丽丽[1] 

机构地区：[1]温州医科大学附属东阳医院,浙江东阳322100

出　　处：《中国急救医学》2015年第1期78-81,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨高龄产妇并发急性胰腺炎的原因、临床早期诊断方法及治疗措施。方法回顾分析我院2010—01～2013—12产科收治的22例合并急性胰腺炎的高龄产妇的临床资料，分析病因、诊断方法及治疗措施。结果22例中胆源性10例（45．5％），高脂血症性9例（40．9％），特发性胰腺炎3例（13．6％）。晚期妊娠13例患者，其中7例孕36～39周患者经保守治疗病情平稳后行剖宫产术，1例孕35周患者经地塞米松促胎肺成熟后终止妊娠，1例妊娠35周＋胆源性SAP患者剖宫产终止妊娠后行“胆囊切除＋胰腺坏死组织清创引流＋空肠造瘘术”，新生儿均存活。1例妊娠30周＋胆源性SAP患者合并急性肺损伤＋糖尿病，保守治疗过程中病情加重，予以引产。1例妊娠30周胆源性SAP患者，发病1d后胎死宫内，引产后予以ERCP乳头切开取石、胰腺及腹腔引流术。1例妊娠29周SAP患者经保守治疗效果不理想，经患者家属要求引产。另外1例妊娠25周血脂高达26．54mmol／L的高脂血症性胰腺炎患者，因为先兆流产，予以引产和血液滤过，以上新生儿均死亡。1例孕38周SAP患者入院时即发生多器官衰竭、弥散性血管内凝血、死胎，经抢救无效死亡。其余8例合并急性胰腺炎患者保守治疗治愈继续妊娠。结论对于妊娠合并轻症胰腺炎的患者，首先尽可能选择保守治疗，一旦病情加重，建议终止妊娠以确保母婴安全。胆源性胰腺炎患者应酌情予以胆结石清除及引流术。高脂血症性胰腺炎应配合降脂治疗，必要时予以血液滤过。早期诊断、个体治疗、适时终止妊娠可有效提高治愈率。Objective To investigate the causes, diagnosis and treatment of acute pancreatitis for pregnant women. Methods This retrospective analysis enrolled 22 cases with acute pancreatitis in our hospital 2010 -01 - 2013 - 12. The patients were divided into two groups, mild acute pancreatitis （MAP） group of 13 cases, 9 cases of severe acute pancreatitis （SAP） group of 9 cases. The obstetric clinical data of advanced maternal age were analyzed for the etiology, diagnostic methods and treatment measures. Data comparison between the two groups was done by Fisher ＂s exact probability method. Results Twenty - two cases of acute pancreatitis included 10 cases gallstone （45.5%） , 9 cases hyperlipidemia （40. 9% ）, 3 cases of idiopathic pancreatitis （ 13. 6% ）. Among 13 third trimester patients, 7 cases of them with 36 - 39 weeks of pregnancy were controlled stable condition by conservative treatment and then received cesarean section, and 1 case of 35 weeks of pregnancy patients with dexamethasone to promote fetal lung maturity ＇after termination of pregnancy, 1 ease of 35 weeks pregnaney termination ＋ gallstone patients with SAP cesarean delivery after gallbladder excision plus drainage of pancreatic necrotic tissue debridement ＋ jejunum colostomy surgery, all newborns survived. One case of 30 weeks of gestation ＋ gallstone patients with SAP ＋ diabetes complicating acute lung injury the illness is aggravating during conservative treatment, so induced labor. One case of 30 weeks of gestation gallstone patients with SAP, fetal intrauterine death, one day ＇after induced labor the patients had a surgery of ERCP nipple cut to take out the stone, as well as the pancreas and abdominal cavity drainage. One case of 29 weeks of gestation SAP patients after conservative treatment is not ideal, the patient ＇s family asked to induce labor. A 25 weeks pregnant pancreatitis patient with severe hyperlipidemia （26.54 mmolfL）, because of threatened abortion, induced labor and hemofihration. One 38 weeks SA

关 键 词：急性胰腺炎 妊娠 高龄 病因 诊断 治疗 

分 类 号：R576[医药卫生—消化系统]