CAJ | 학술논문

目的观察行胰腺功能系统检查的危重死亡患儿临床与病理特征,分析脓毒性休克、脓毒症,乳酸水平与胰腺损害的关系.方法分析湖南省儿童医院2009年1月至2012年10月行胰腺功能系统观察,并因病情危重抢救死亡后行全身和胰腺病理检查的64例危重患儿临床及病理资料,观察所有病例的胰腺组织学特征,并进行病理学分级评分.结果 (1)脓毒性休克患者胰腺组织病理学评分、入院24h血脂肪酶最高值较非脓毒性休克患者显著升高,而住院期间Ca2+最低值显著降低(P＜0.05)；(2)乳酸升高≥2倍组较乳酸升高＜2倍组及乳酸正常组胰腺组织病理学评分显著升高(P＜0.05),但住院期间Ca2+最低值、入院24h血淀粉酶、脂肪酶、尿淀粉酶含量乳酸升高≥2倍组与乳酸升高＜2倍组及乳酸正常组比较差异无统计学意义；(3)胰腺组织病理学评分＞4分组入院24h血淀粉酶、脂肪酶、尿淀粉酶含量较胰腺组织病理学评分≤4分组显著增高(P＜0.05),但胰腺组织病理学评分＞3分组与胰腺组织病理学评分≤3分组比较差异无统计学意义.结论 (1)脓毒性休克患者,尤其是脓毒性休克合并高乳酸血症患者更容易造成胰腺功能损害；(2)胰腺组织病理学评分＞4分能作为判断胰腺损害的有效指标.
목적 관찰행이선공능계통검사적위중사망환인림상여병리특정,분석농독성휴극、농독증,유산수평여이선손해적관계.방법 분석호남성인동의원2009년1월지2012년10월행이선공능계통관찰,병인병정위중창구사망후행전신화이선병리검사적64례위중환인림상급병리자료,관찰소유병례적이선조직학특정,병진행병이학분급평분.결과 (1)농독성휴극환자이선조직병이학평분、입원24h혈지방매최고치교비농독성휴극환자현저승고,이주원기간Ca2+최저치현저강저(P＜0.05)；(2)유산승고≥2배조교유산승고＜2배조급유산정상조이선조직병이학평분현저승고(P＜0.05),단주원기간Ca2+최저치、입원24h혈정분매、지방매、뇨정분매함량유산승고≥2배조여유산승고＜2배조급유산정상조비교차이무통계학의의；(3)이선조직병이학평분＞4분조입원24h혈정분매、지방매、뇨정분매함량교이선조직병이학평분≤4분조현저증고(P＜0.05),단이선조직병이학평분＞3분조여이선조직병이학평분≤3분조비교차이무통계학의의.결론 (1)농독성휴극환자,우기시농독성휴극합병고유산혈증환자경용역조성이선공능손해；(2)이선조직병이학평분＞4분능작위판단이선손해적유효지표.
Objective To study the exocrine pancreatic function in critically ill children with septic shock,sepsis and hyperlactacidemia.Methods A total of 64 critical pediatric patients were admitted from Jan 2009 to Oct 2012,and clinical and laboratory findings including pancreatic function,and histopathological features and score after autopsy were reviewed.Results (1) Compared with non-septic shock children,the pancreatic pathology score and serum lipase in septic shock group were significantly higher and serum calcium was significantly reduced (P ＜0.05) ; (2) The pancreatic histopathology score was significantly increased in patients with elevated plasma lactate ≥2 times (P ＜0.05),but there were no significant differences in serum calcium and blood amylase and lipase between patients with elevated plasma lactate level and patients with normal plasma lactate level; (3) The concentrations of serum amylase,lipase and urinary amylase were significantly increased in patients with pancreatic histopathology score ＞4 points compared with score ≤4 points patients,but there were no significant differences in above three biomarkers between patients with score ≤3 points and patients with score ＞3 points.Conclusions The pancreas is vulnerable to damage easily occurred in septic shock children especially complicated with hyperlactacidemia.The pancreatic histopathology score ＞ 4 points can be as a sensitive and reliable indicator of pancreas damage.