老年重症急性胰腺炎的临床特点  

The clinical characteristics of elderly patients with acute severe pancreatitis

作　　者：龙思泽[1] 白一景[1] 

机构地区：[1]阆中市人民医院消化内科,四川阆中637400

出　　处：《当代医学》2018年第5期32-34,共3页Contemporary Medicine

摘　　要：目的探讨老年重症急性胰腺炎(SAP)患者的临床特点。方法回顾性分析本院2011年1月~2013年6月住院老年SAP患者(≥60岁)临床资料65例,并与同期48例非老年SAP患者(<60岁)对病因学、基础疾病、并发症、多项临床评分等方面进行比较。结果老年SAP以女性患者居多,男女比例1∶2.25,老年组死亡率13.8%,非老年组10.4%,差异无统计学意义,死亡原因均为多器官功能衰竭(MODS)。老年SAP前三位病因依次为胆源性(70.8%)、特发性18.4%、脂源性(6.2%),而非老年组依次为胆源性(64.6%)、脂源性(18.7%)、酒精性(10.4%)。基础疾病高血压、冠心病、慢性阻塞性肺疾病(COPD)在老年组中更为常见(P<0.05)。而脂肪肝比例明显低于非老年组(P<0.05)。肝功能异常、急性肺损伤(ALI)和(或)急性呼吸窘迫综合征(ARDS)、电解质紊乱,心功能不全、MODS是两组最常见的并发症,老年组中趋向于更常见,但差别无统计学意义。老年组APACHEII和Ranson评分明显升高,而Balthazar CT评分低于非老年组,差异有统计学意义(P<0.05)。结论老年SAP中以女性居多,胆源性是其首要病因,基础疾病及并发症多,MODS是其主要死亡原因,治疗以监测和改善主要器官功能,阻止MODS的发生为重点,注意补液量控制及全身情况平衡。Objective To investigated the clinical characteristics of the patients with severe acute pancreatitis(SAP). Methods A retrospective analysis of our hospital from January 2011 to June 2013 hospitalized elderly SAP patients(over 60 years) clinical data of 65 patients, and compared with 48 cases of non elderly SAP patients(<60 years) to compare the etiology, complications, clinical score etc. Results The SAP to the majority of female patients, male to female ratio was 1:2.25, the mortality rate was 13.8% in elderly group, and 10.4% in nonelderly, the difference was not statistically significant. The cause of death was multiple organ dysfunction syndrome(MODS). The top three causes in elderly group were biliary(70.8%), idiopathic(18.4%), high triglyceride(6.2%), while in the nonelderly group were biliary(64.6%), high triglyceride(18.7%), alcohol(10.4%).The underlying disease, coronary heart disease, hypertension and chronic obstructive pulmonary disease(COPD) is more common in elderly group(P<0.05). The ratio of fatty liver was significantly lower than that in the non elderly group(P<0.05). Abnormal liver function, acute lung injury(ALI) and(or) acute respiratory distress syndrome(ARDS), electrolyte disorders, heart failure, MODS is the most common complication of two groups, tend to be more common in the elderly group, but the difference was not statistically significant. APACHEII and Ranson score were significantly higher in the elderly group, and Balthazar CT score was lower than that in the nonelderly group, the difference was statistically significant(P<0.05). Conclusion Elderly patients with SAP are more common in women, and gallstone is the primary cause, and more basic diseases and complications compared with nonelderly. MODS was the main reason of death. Pay attention to control the rehydration, monitor and improve the function of major organs, thereby preventing the occurrence of MODS as the key point is very important.

关 键 词：重症急性胰腺炎 老年 病因 

分 类 号：R576[医药卫生—消化系统]