中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2012年
6期
366-370
,共5页
杜奕奇%湛先保%谢沛%董元航%陈燕%于齐宏%郭晓榕%郭杰芳%张文俊%施新岗%李建萍%蔡晔%张圣道%李兆申
杜奕奇%湛先保%謝沛%董元航%陳燕%于齊宏%郭曉榕%郭傑芳%張文俊%施新崗%李建萍%蔡曄%張聖道%李兆申
두혁기%담선보%사패%동원항%진연%우제굉%곽효용%곽걸방%장문준%시신강%리건평%채엽%장골도%리조신
胰腺炎,急性坏死性%回顾性研究%多器官功能衰竭%综合疗法
胰腺炎,急性壞死性%迴顧性研究%多器官功能衰竭%綜閤療法
이선염,급성배사성%회고성연구%다기관공능쇠갈%종합요법
Pancreatitis,acute necrotizing%Retrospective studies%Multiple organ failure%Combined modality therapy
目的 探讨内科综合治疗在重症急性胰腺炎(SAP)救治中的价值.方法 回顾性总结长海医院消化内科2000年1月至2011年12月收治的931例(共1064例次)患者资料.分析SAP的发病诱因、病情评分、并发症、治疗措施、疗效及费用等.结果 931例患者中,男性559例,女性372例,平均年龄(51±15)岁.胆源性为SAP最主要的发病诱因(58.3％),其次是高脂饮食(31.2％)、高脂血症(13.6％)和饮酒(7.1％).入院时Balthazar CT评分D级以上者占95.5％,Ranson评分≥3分者占26.0％,APACHEⅡ评分≥8分者占30.1％.42.7％的SAP患者合并全身炎症反应综合征(SIRS),24.0％合并急性肺损伤或急性呼吸窘迫综合征,8.1％合并急性肾损伤,5.4％出现休克或心衰,3.2％合并急性肝损伤,1.0％出现弥散性血管内凝血.其他并发症包括腹腔出血17例、假性囊肿出血9例、胰周脓肿78例和消化道瘘33例.主要治疗措施包括辅助呼吸、血液滤过、腹腔灌洗、穿刺引流、营养支持及内镜介入和手术治疗.院内病死25例(2.3％),放弃治疗出院36例(3.4％),总体抢救成功率为94.3％.平均住院天数为(23.7±19.2)d,平均住院费用为5.23万元.结论 建立以内科综合治疗为基础、以脏器功能维护为重点、以微创介入为手段的综合救治模式有助于提高SAP的救治成功率,值得进一步推广.
目的 探討內科綜閤治療在重癥急性胰腺炎(SAP)救治中的價值.方法 迴顧性總結長海醫院消化內科2000年1月至2011年12月收治的931例(共1064例次)患者資料.分析SAP的髮病誘因、病情評分、併髮癥、治療措施、療效及費用等.結果 931例患者中,男性559例,女性372例,平均年齡(51±15)歲.膽源性為SAP最主要的髮病誘因(58.3％),其次是高脂飲食(31.2％)、高脂血癥(13.6％)和飲酒(7.1％).入院時Balthazar CT評分D級以上者佔95.5％,Ranson評分≥3分者佔26.0％,APACHEⅡ評分≥8分者佔30.1％.42.7％的SAP患者閤併全身炎癥反應綜閤徵(SIRS),24.0％閤併急性肺損傷或急性呼吸窘迫綜閤徵,8.1％閤併急性腎損傷,5.4％齣現休剋或心衰,3.2％閤併急性肝損傷,1.0％齣現瀰散性血管內凝血.其他併髮癥包括腹腔齣血17例、假性囊腫齣血9例、胰週膿腫78例和消化道瘺33例.主要治療措施包括輔助呼吸、血液濾過、腹腔灌洗、穿刺引流、營養支持及內鏡介入和手術治療.院內病死25例(2.3％),放棄治療齣院36例(3.4％),總體搶救成功率為94.3％.平均住院天數為(23.7±19.2)d,平均住院費用為5.23萬元.結論 建立以內科綜閤治療為基礎、以髒器功能維護為重點、以微創介入為手段的綜閤救治模式有助于提高SAP的救治成功率,值得進一步推廣.
목적 탐토내과종합치료재중증급성이선염(SAP)구치중적개치.방법 회고성총결장해의원소화내과2000년1월지2011년12월수치적931례(공1064례차)환자자료.분석SAP적발병유인、병정평분、병발증、치료조시、료효급비용등.결과 931례환자중,남성559례,녀성372례,평균년령(51±15)세.담원성위SAP최주요적발병유인(58.3％),기차시고지음식(31.2％)、고지혈증(13.6％)화음주(7.1％).입원시Balthazar CT평분D급이상자점95.5％,Ranson평분≥3분자점26.0％,APACHEⅡ평분≥8분자점30.1％.42.7％적SAP환자합병전신염증반응종합정(SIRS),24.0％합병급성폐손상혹급성호흡군박종합정,8.1％합병급성신손상,5.4％출현휴극혹심쇠,3.2％합병급성간손상,1.0％출현미산성혈관내응혈.기타병발증포괄복강출혈17례、가성낭종출혈9례、이주농종78례화소화도루33례.주요치료조시포괄보조호흡、혈액려과、복강관세、천자인류、영양지지급내경개입화수술치료.원내병사25례(2.3％),방기치료출원36례(3.4％),총체창구성공솔위94.3％.평균주원천수위(23.7±19.2)d,평균주원비용위5.23만원.결론 건립이내과종합치료위기출、이장기공능유호위중점、이미창개입위수단적종합구치모식유조우제고SAP적구치성공솔,치득진일보추엄.
Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.
