早期与晚期进行超声引导下经皮穿刺引流在伴有休克的急性坏死性胰腺炎患者中的应用对比:一项回顾性研究  

Early versus late ultrasonography-guided percutaneous catheter drainage for acute necrotizing pancreatitis with septic shock: a retrospective cohort study

作　　者：陈雷[1] 张晓菲[1] 王丽纯[1] 寇秋野[1] CHEN Lei;ZHANG Xiao-fei;WANG Li-chun;KOU Qiu-ye(Department of ICU,the Sixth Affliated Hospital of Sun Yat-sen University,Guangzhou 510655,China.)

机构地区：[1]中山大学附属第六医院ICU,广州510655

出　　处：《中国处方药》2018年第11期7-9,共3页Journal of China Prescription Drug

摘　　要：目的探讨早期经超声引导经皮穿刺引流(PCD)治疗伴有休克的坏死性胰腺炎的疗效。方法选取2014年1月～2016年12月期间收入ICU伴有休克的坏死性胰腺炎、并进行超声引导下PCD治疗患者28例,对其临床资料进行回顾性分析。发病4周以内进行PCD的为早期PCD组(20例);发病4周以后进行PCD的定义为晚期PCD组(8例)。收集两组患者的基本情况,观察主要指标为全因死亡率;次要指标包括PCD治疗前、后的器官功能评估、PCD的并发症和住院资源利用情况。结果 28例患者总体全因死亡率为21.4%(6/28),早期和晚期PCD组的全因死亡率分别为15%和37.5%,差异无统计学意义(P=0.208)。早期PCD组患者在儿茶酚胺类药物使用时间、机械通气时间、CRRT持续时间和腹腔高压持续时间上均明显短于晚期PCD组;而且两组在PCD治疗后的腹腔压力明显低于PCD治疗前;在早期PCD组治疗后的SOFA评分也较治疗前有明显下降。早期PCD组患者的住院时间也比晚期PCD组显著缩短。结论在两组伴有休克的坏死性胰腺炎患者的基本特征相似的情况下,早期给予超声引导下PCD治疗的患者具有更短的器官功能支持时间和住院时间。Background The percutaneous catheter drainage （PCD） for necrotizing pancreatitis （NP） has been widely recommended. However, the timing of PCD should be performed after 4 weeks of onset, when the necrosis has been sufficiently walled off. We aim to investigate the clinical effects of early versus late PCD for acute NP with septic shock. Methods This is a retrospective cohort study of NP patients who had been performed with ultrasonography-guided PCD from January 2014 to December 2016. The patients who were given PCD within 4 weeks was considered as early group （n =20）, compared to those after 4 weeks as late group （n =8）. Our primary outcome was all-cause mortality; secondary outcomes included organ function assessment before and after PCD, complications after drainage, and hospital care resource utilization. Results Twenty-eight patients were included. Total all-cause mortality rate was 21.4% （six patients）. The CT severity index was similar between early group and late group （median, 9 vs. 9, P =0.830）. There was no difference in basic APACHEⅡ （median, 20 vs. 22, P =0.571）, SOFA score （median, 9 vs. 9, P =0.903） and Marshall score （median, 7 vs. 7, P =0.652）. Median initial time to early and late PCD was 7 and 38 days, respectively. Early group was not significantly different to late group in mortality rate （15% vs. 37.5%, P =0.208）. Regardless of the time of catecholamine use, mechanical ventilation time, CRRT time or duration of IAH, the early group was shorter than the late group （P = 0.004, P = 0.038, P = 0.007 and P = 0.020, respectively）. SOFA scores after PCD in early group were significantly lower than before PCD （P=0.005）, and the intra-abdominal pressure before PCD in both groups was significantly higher than that after PCD （P = 0.011 and P = 0.019, respectively）. The length of staying （LOS） in early group were longer than in late group （median, 42 d vs. 90 d, P 〈0.001）.Conclusion Even though NP patients with septi

关 键 词：经皮穿刺引流 坏死性胰腺炎 休克 治疗时机 

分 类 号：R576[医药卫生—消化系统]