猪尾巴管腹腔灌洗治疗急性重症胰腺炎介入时机的临床研究  

Clinical study on the time of interventional therapy for acute severe pancreatitis with peritoneal lavage with pigtail tube

作　　者：吴本华 周应生 雷平光 WU Benhua;ZHOU Yingsheng;LEI Pingguang(Guangming New District People's Hospital,Shenzhen 518106,China;Songgang People’s Hospital,Shenzhen 518103,China)

机构地区：[1]深圳市光明新区人民医院,广东深圳518106 [2]深圳市松岗人民医院,广东深圳518103

出　　处：《中国医药科学》2017年第15期154-157,241,共5页China Medicine And Pharmacy

基　　金：广东省深圳市宝安区科技计划项目(2014237)

摘　　要：目的探讨猪尾巴管腹腔灌洗治疗急性重症胰腺炎介入时机的选择。方法采用回顾性队列研究方法,选择2014年3月~2016年10月我院收治60例重症急性胰腺炎患者作为研究对象,在一般保守治疗的基础上,加用猪尾巴管腹腔灌洗治疗,根据介入时机(24h内、48h内、72h内)分为A、B、C组,每组20例;根据B超检查是否可见腹腔积液分为D组和E组;以C反应蛋白(CRP)值、APACHE II值、中性粒细胞计数(NEU)、全身炎症反应综合征(SIRS)持续时间、加用连续肾脏替代疗法(CRRT)例数和死亡例数作为观察指标。结果 A、B、C组治疗前CRP值、APACHE II值、NEU比较差异无统计学意义(P>0.05);治疗第7天,A、B、C组CRP值、APACHE II值、NEU均较治疗前下降,差异有统计学意义(P<0.01),且组间比较差异有统计学意义(P<0.05);随着猪尾巴管腹腔灌洗治疗时间的延迟,CRP值、APACHE II值、NEU下降程度随之减小,差异有统计学意义(P<0.05);A、B、C组无死亡病例,SIRS持续时间、加用CRRT例数比较差异有统计学意义(P<0.05);D组经B超检查可见腹腔积液,共35例;E组经B超检查未见腹腔积液,共25例;D组与E组治疗前腹腔内压比较差异有统计学意义(P<0.05);D组与E组治疗第7d,腹腔内压均较治疗前下降,差异有统计学意义(P<0.01),且组间比较差异有统计学意义(P<0.05)。结论不同的猪尾巴管腹腔灌洗介入时机在急性重症胰腺炎治疗中的效果不同,若经B超检查可见腹腔积液,在24小时内加用猪尾巴管腹腔灌洗治疗作为最佳的介入时机。Objective To explore the time of interventional therapy for acute severe pancreatitis with peritoneal lavage withpigtail tube.Methods Retrospective cohort study method was used.60patients with severe acute pancreatitis cured in ourhospital grom March2014to October2016were selected as the study object.On the basis of general conservative treatment,thepig tail tube was used for abdominal lavage.They were divided into group A,group B and group C,according to the timing ofintervention(24h,48h,72h),with20patients in each group.According to B ultrasonic examination,peritoneal effusion was dividedinto group D and group E.The C reactive protein(CRP),APACHE,II,neutrophil count(NEU),systemic inflammatory responsesyndrome(SIRS)duration,and the number of consecutive renal replacement therapy(CRRT)cases and deaths were used asobservation indicators.Results There were no statistical significance on CRP value,APACHE,II value,and NEU between the threegroups.On the7d after treatment,the CRP value,APACHE,II value,NEU of group A,group B and group C were lower than beforetreatment,there were significant differences(P<0.01),and there were differences between groups(P<0.05).With the delayof peritoneal lavage treatment,the decrease of CRP,APACHE,II and NEU decreased(P<0.05).There were no deaths in groupA,group B and group C.The duration of SIRS and the number of CRRT cases were compared(P<0.05).In group D,ascites wasdetected by ultrasonography,and there were35cases.The E group had no peritoneal effusion after B ultrasonic examination,andthere were25cases.There were differences in the intra abdominal pressure before and after treatment in group D and group E(P<0.05).In group D and group E,on the7D after treatment,intraperitoneal pressure decreased significantly,compared with beforetreatment(P<0.01),and there were differences between groups(P<0.05).Conclusion Different pig tail tubes,peritoneallavage,interventional timing in the treatment of severe acute pancreatitis have different effects.If the ultrasound examination showsperitoneal ef

关 键 词：急性重症胰腺炎 腹腔灌洗 介入时机 

分 类 号：R576[医药卫生—消化系统]