CAJ | 학술논문

目的探讨小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗早期重症急性胰腺炎(SAP)患者的临床价值.方法回顾分析2003年至2011年焦作市人民医院胰腺外科采用小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗26例早期SAP患者的临床资料.结果术后第1天患者的体温、脉搏、呼吸、APACHEⅡ评分、腹腔压力、中心静脉压、血糖、WBC、PaCO2、三酰甘油、肌酐分别为(37.4±0.9)℃、(104±13)次/rain、(21 ±5)次/min、(12.3±4.0)分、(11.8±2.1)cm H2O(l cmH2O=0.098 kPa)、(18.2 ±0.6)cm H2O、(7.7±0.6) mmol/L、(9.54 ±2.80)×109/L、(42.40 ±4.72)mm Hg(l mm Hg =0.133 kPa)、(13.83±1.01) mmol/L、(215.6±3.5) μmol/L,较术前显著下降,差异均有统计学意义(P值均＜0.01).术后第1天尿量、PaO2、平均动脉压(MAP)分别为(90.6±4.5) ml/h、(88.15 ±3.02)mm Hg、(84.8 ±3.4)mm Hg,较术前显著增加,差异有统计学意义(P值均＜0.01).术前发生呼吸窘迫综合征22例(84.6％),急性肾功能衰竭15例(57.6％),休克14例(53.8％),全身炎症反应综合征22例(84.6％),术后分别下降至2例(7.6％)、l例(3.8％)、1例(3.8％)、3例(11.5％).术后发生肠瘘2例(7.6％),胰瘘3例(11.5％),腹腔内出血2例(7.6％),真菌感染12例(46.2％).全组治愈率92.3％(24/26),病死率7.7％(2/26).结论小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗早期SAP效果满意,能显著地提高患者生存率,降低病死率.
목적 탐토소망막낭、량측복막후창개관세연합구역동맥약물관주치료조기중증급성이선염(SAP)환자적림상개치.방법 회고분석2003년지2011년초작시인민의원이선외과채용소망막낭、량측복막후창개관세연합구역동맥약물관주치료26례조기SAP환자적림상자료.결과 술후제1천환자적체온、맥박、호흡、APACHEⅡ평분、복강압력、중심정맥압、혈당、WBC、PaCO2、삼선감유、기항분별위(37.4±0.9)℃、(104±13)차/rain、(21 ±5)차/min、(12.3±4.0)분、(11.8±2.1)cm H2O(l cmH2O=0.098 kPa)、(18.2 ±0.6)cm H2O、(7.7±0.6) mmol/L、(9.54 ±2.80)×109/L、(42.40 ±4.72)mm Hg(l mm Hg =0.133 kPa)、(13.83±1.01) mmol/L、(215.6±3.5) μmol/L,교술전현저하강,차이균유통계학의의(P치균＜0.01).술후제1천뇨량、PaO2、평균동맥압(MAP)분별위(90.6±4.5) ml/h、(88.15 ±3.02)mm Hg、(84.8 ±3.4)mm Hg,교술전현저증가,차이유통계학의의(P치균＜0.01).술전발생호흡군박종합정22례(84.6％),급성신공능쇠갈15례(57.6％),휴극14례(53.8％),전신염증반응종합정22례(84.6％),술후분별하강지2례(7.6％)、l례(3.8％)、1례(3.8％)、3례(11.5％).술후발생장루2례(7.6％),이루3례(11.5％),복강내출혈2례(7.6％),진균감염12례(46.2％).전조치유솔92.3％(24/26),병사솔7.7％(2/26).결론 소망막낭、량측복막후창개관세연합구역동맥약물관주치료조기SAP효과만의,능현저지제고환자생존솔,강저병사솔.
Objective To investigate the effectiveness of lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion for the treatment of early severe acute pancreatitis (SAP).Methods The clinical data of 26 cases of early SAP who underwent lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion from 2003 to 2011 were retrospectively evaluated in Department of Pancreatic Surgery,Jiaozuo People's Hospital.Results At 1st day after operation,the body temperature,pulse,respiratory rate,APACHE Ⅱ score,abdominal pressure,central venal pressure (CVP),blood glucose,WBC,PaCO2,triglycerides,creatinine were (37.4±0.9) ℃,(104 ± 13)/min,(21 ±5)/min,(12.3 ±4.0),(11.8 ±2.1)cm H2O (lcm H2O =0.098 kPa),(18.2 ±0.6) cm H2O,(7.7 ±0.6)mmol/L,(9.54±2.80) × 109/L,(42.40±4.72)mm Hg (1 mm Hg=0.133 kPa),(13.83 ± 1.01) mmol/L,(215.6±3.5) μmol/L,which were significantly lower than those before operation,and the difference between the two groups was statistically significant (P ＜0.01).At 1st day after operation,urine output,PaO2,mean arterial pressure (MAP) were (90.6 ± 4.5) ml/h,(88.15 ± 3.02) mmHIg,(84.8 ± 3.4) mmHg,which were significantly higher than those before operation,and the difference between the two groups was statistically significant (P＜0.01).ARDS,acute renal failture,shock,SIRS occurred in 22 (84.6％),15(57.6％),14(53.8％) and 22(84.6％) cases,which were decreased to 2(7.6％),1 (3.8％),1 (3.8％) and 3 (11.5％) after treatment.Postoperative intestinal fistula,pancreatic fistula,intraperitoneal bleeding,fungal infection occurred in 2 (7.6％),3 (11.5％),2 (7.6％),12 (46.2％) patients.The cure rate and mortality rates was 92.3％ (24/26) and 7.7％ (2/26) respectively.Conclusions Lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion are effective for the treatment of early SAP,which can significantly improve survival and reduce mortality.