早期腹腔穿刺引流对重症急性胰腺炎患者疗效和预后的分析  

Clinical efficacy and outcome analysis of early abdominal paracentesis drainage for treating patients with severe acute pancreatitis

作　　者：郑晶晶 谢晖[1] 俞戈 金珊珊 黄文杰 胡国勇 王瑞兰[1,3] Zheng Jingjing;Xie Hui;Yu Ge;Jin Shanshan;Huang Wenjie;Hu Guoyong;Wang Ruilan(Department of Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Gastroenterology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Shanghai Key Laboratory of Pancreatic Diseases,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院急诊危重病科,上海200080 [2]上海交通大学医学院附属第一人民医院消化内科,上海200080 [3]上海市胰腺疾病重点实验室,上海200080

出　　处：《中华胰腺病杂志》2023年第2期114-119,共6页Chinese Journal of Pancreatology

基　　金：上海申康医院发展中心临床科技创新项目(SHDC22021211)。

摘　　要：目的探讨早期腹腔穿刺引流(APD)对SAP患者疗效和预后的影响。方法收集2017年5月至2021年12月间上海市第一人民医院收治的107例合并大量腹水的SAP患者临床资料,根据患者入院3 d内是否行腹腔穿刺引流(APD)分为APD组(56例)和非APD组(51例)。APD组再根据穿刺时是否已发生腹腔间隔室综合征(ACS)分为ACS亚组(29例)与非ACS亚组(27例)。记录患者的一般临床资料、全身炎症反应综合征(SIRS)持续时间、ICU住院时间、入院后1~3 d腹腔内压及炎症指标(白细胞计数及C反应蛋白水平)变化趋势、感染并发症发生率、升阶梯治疗情况、出院或死亡情况等。结果APD组与非APD组患者的腹腔内压分别为(18.6±5.6)、(13.7±4.2)mmHg(1 mmHg=0.133 kPa),APD组较非APD组更高,差异有统计学意义(P=0.000)。与非APD组比较,APD组SIRS持续时间更短[3(2,4)d比4(3,6)d,P=0.029]。入院后1~3 dAPD组腹腔内压分别为(18.6±5.6)、(16.4±4.7)、(13.5±3.9)mmHg,非APD组为(13.7±4.2)、(12.3±3.6)、(11.0±2.6)mmHg,与非APD组比较,APD组腹腔压力下降更快(P=0.004);APD组白细胞计数分别为(14.8±4.8)、(10.5±4.5)、(9.0±3.8)×109/L,非APD组分别为(14.2±5.4)、(12.3±7.3)、(11.7±5.3)×109/L,与非APD组比较,APD组白细胞计数下降速度更快(P=0.006);APD组C反应蛋白分别为(153.6±47.1)、(150.4±10.5)、(108.8±49.4)mg/L,非APD组分别为(174.8±31.1)、(191.6±29.4)、(186.8±45.5)mg/L,APD组C反应蛋白含量显著下降,而非APD组未见下降趋势,差异有统计学意义(P=0.009)。两亚组比较,ACS亚组SIRS持续时间长于非ACS组[4(3,5)d比2(1,3)d,P=0.000]。两组及两亚组患者的ICU住院时间、感染并发症发生率、治疗进阶率及病死率差异均无统计学意义。结论对合并腹腔积液的SAP患者,早期APD可减少SIRS持续时间,快速降低腹内压,改善炎症指标,但并不能显著改善患者的预后。Objective To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage(APD)in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed.Patients were divided into APD group(n=56)and NO-APD group(n=51)according to whether they underwent APD or not within 3 days after admission.The APD group was then divided into abdominal compartment syndrome(ACS)subgroup(n=29)and NO-ACS subgroup(n=27)according to whether ACS had occurred or not at the time of puncture.Patients'general data,the duration of systemic inflammatory response(SIRS),length of ICU stay,the trends of intra-abdominal pressure and inflammatory indicators(white blood cell count and the content of C-reactive protein)within 1-3 days after admission,incidence of infection complication,step-up therapy,discharge or death were recorded.Results The intra-abdominal pressure were 18.6±5.6mmHg,13.7±4.2mmHg(1 mmHg=0.133 kpa)in APD group and NO-APD group,respectively.The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group,and the difference was statistically significant(P=0.000).Compared with NO-APD group,the duration of SIRS was significantly shortened in APD group[3(2,4)days vs 4(3,6)days,P=0.029].On day 1,2 and 3 after admission,the intra-abdominal pressure was 18.6±5.6 mmHg,16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group,and was 13.7±4.2 mmHg,12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group,respectively.The intra-abdominal pressure of the APD group dropped faster than the NO-APD group(P=0.004).The white blood cell count was(14.8±4.8),(10.5±4.5)and(9.0±3.8)×109/L in APD group,and was(14.2±5.4),(12.3±7.3),(11.7±5.3)×109/L in NO-APD group,respectively.Compared with the NO-APD group,the decrease rate of white blood cell count was faster in APD group(P=0.006).The C-reactive protein content was(153.6±47.1),(150.4±10.5)and(108.8±49.4)mg/L in

关 键 词：胰腺炎 急性坏死性 腹水 引流术 穿刺时机 

分 类 号：R576[医药卫生—消化系统]