妊娠期高脂血症性急性胰腺炎5例临床病例并文献复习  

Five clinical cases of acute pancreatitis with hyperlipidemia during pregnancy and literature review

作　　者：李丹 郑秀惠 李力 LI Dan;ZHENG Xiuhui;LI Li(Department of Obstetrics and Gynecology,Army Specialty Medical Center of PLA,Chonqing,400042,China)

机构地区：[1]陆军特色医学中心妇产科,重庆400042

出　　处：《重庆医学》2023年第3期409-413,418,共6页Chongqing medicine

摘　　要：目的 研究妊娠期高脂血症性急性胰腺炎(HLAPIP)的早期诊断和治疗方案对预后的影响。方法 回顾性分析该院2018年1月至2021年4月期间收治的5例HLAPIP患者的临床特征、诊疗经过及母儿结局。结果 5例病例孕前均未发现有消化系统疾病,均从孕早期开始偏高脂饮食,发病前无暴饮暴食;所有病例发病的首发症状均有上腹痛、恶心、呕吐,均无发热;5例病例均在首次采血时发现血液呈淡红色乳糜状分层。2例首次B超检查未发现胰腺病变,3例产前通过磁共振成像(MRI)检查确诊胰腺病变,1例产前通过计算机断层扫描(CT)确诊胰腺病变。3例未足月患者要求继续维持妊娠,经全面评估病情,并取得书面知情同意,在重症医学科给予血浆置换联合持续性肾脏替代治疗,其中2例好转出院后持续妊娠至足月分娩,新生儿出生时Apgar评分及脐动脉血气分析正常;1例腹痛症状改善不明显,且有胎儿窘迫征象,于治疗第3天终止妊娠。2例足月妊娠入院后立即剖宫产终止妊娠,1例好转出院,1例因腹腔引流量持续增加行胰腺穿刺引流,好转出院后急性胰腺炎反复发作,此2例的新生儿出生后Apgar评分及脐动脉血气分析均无特殊。结论 HLAPIP的病情发展快,早期诊断、个体化治疗、适时终止妊娠可有效改善母儿结局。Objective To study the effect of early diagnosis and treatment options on prognosis of Hyperlipidemia acute pancreatitis in pregnancy(HLAPIP) during pregnancy.Methods The clinical characteristics, diagnosis and treatment process, and maternal and child outcomes of five patients with HLAPIP admitted to this hospital from January 2018 to April 2021 were retrospectively analyzed.Results None of the five cases were found to have digestive system diseases before pregnancy, and they all started to eat a high-fat diet from the first trimester, and there was no overeating before the onset.The initial symptoms of all cases were epigastric pain, nausea, vomiting, and no fever.In all five cases, the blood was found to be pale red chylous stratification when the blood was collected for the first time.Pancreatic lesions were not found in the first B-ultrasound in two cases, three cases were diagnosed by prenatal magnetic resonance imaging(MRI),and 1 case was diagnosed by prenatal computed tomography(CT).A total of three cases of preterm patients requested to continue to maintain the pregnancy.After a comprehensive assessment of the condition, and written informed consent was obtained, plasma exchange combined with continuous renal replacement therapy was given in the Department of Critical Care Medicine.Among them, two cases improved and continued to be pregnant to term delivery after being discharged from hospital.Apgar score and umbilical artery blood gas analysis of neonates were normal at birth.In one case, the symptoms of abdominal pain were not improved significantly, and there were signs of fetal distress, and the pregnancy was terminated on the 3rd day of treatment.A total of two cases of full-term pregnancy were terminated by cesarean section immediately after admission, one case improved and was discharged from hospital, one case underwent pancreatic puncture and drainage due to continuous increase of abdominal drainage volume, and the acute pancreatitis recurred after improvement and discharge.The two cases’ neon

关 键 词：妊娠期 高脂血症 急性胰腺炎 血浆置换 

分 类 号：R714.7[医药卫生—妇产科学]