重症急性高脂血症性胰腺炎与重症急性胆石性胰腺炎的临床特点比较  

Comparison of clinical characteristics of severe hyperlipidemic pancreatitis and severe acute gallstone pancreatitis

作　　者：杨磊[1] 张超[1] 刘大川[1] 贾建国[1] 李非[1] 

机构地区：[1]首都医科大学宣武医院普通外科,北京100053

出　　处：《中华全科医师杂志》2017年第9期692-695,共4页Chinese Journal of General Practitioners

摘　　要：目的 探讨析重症急性高脂血症性胰腺炎（SHLP）与重症急性胆石性胰腺炎（SAGP）的临床特点和治疗经验.方法 回顾性分析宣武医院2009年1月1日至2015年12月31日收治的22例SHLP和91例SAGP患者的临床资料,比较其临床表现、实验室检查、入院后30 d器官功能障碍特点、内科治疗与转归.结果 SHLP组中男性16例、女性6例,平均年龄（60.5±9.1）岁;SAGP组中,男性32例、女性59例,平均年龄（54.3±5.4）岁.SHLP组发病24 h内血、尿淀粉酶水平低于SHLP组[血淀粉酶：（715±99）比（1 551±107） U/L,=4.65,P=0.00;尿淀粉酶：（382±56）比（773±66） U/L,t =4.52,P=0.00],入院30 d内循环功能不全、呼吸功能不全、肾功能不全、远期肺部感染发生率显著高于SAGP患者[8（36％）比13（14％）,x2=5.22,P=0.01;9（41％）比6（7％）,x2 =9.46,P=0.01;5（23％）比5（5％）,x2=4.20,P=0.03;12（55％）比29（32％）,x2=7.02,P=0.01].治疗过程中因感染、心脏事件及出血等原因,SHLP组死亡2例,SAGP组死亡9例.结论 在诊断时应注意SHLP常不伴有血、尿淀粉酶的显著升高,在治疗重症高脂血症胰腺炎过程中需比重症急性胆石性胰腺炎更积极治疗循环功能不全、呼吸器官功能不全和肾功能不全的发生.Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis （SHLP） and severe acute gallstone pancreatitis （SAGP）.Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of （60.5 ± 9.1） years in SHLP group;while 32 males and 59 females with a mean age of （54.3 ± 5.4） years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [（715 ±99） U/L vs.（1 551 ± 107） U/L,t =4.65,P =0.00;（382 ±56） U/L vs.（773 ± 66） U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 % （8/22） vs.14 % （13/91）,x2 =5.22,P =0.01;41% （9/22） vs.7 % （6/91）,x2 =9.46,P =0.01;23%（51/22） vs.5% （5/91）,x2 =4.20,P=0.03;55%（12/22） vs.32% （29/91）,x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

关 键 词：胰腺炎 高脂血症 胆石 胰腺α-淀粉酶 

分 类 号：R576[医药卫生—消化系统]