医学综述
醫學綜述
의학종술
MEDICAL RECAPITULATE
2014年
23期
4384-4385,4393
,共3页
重症急性胰腺炎%老年人%非手术综合治疗
重癥急性胰腺炎%老年人%非手術綜閤治療
중증급성이선염%노년인%비수술종합치료
Severe acute pancreatitis%Elderly%Non-surgical treatment
目的：探讨老年重症急性胰腺炎（ SAP）的发病特点及治疗策略。方法回顾性分析2005年12月至2012年12月天津市武清区人民医院收治的56例老年SAP患者（老年组）的临床资料，并与同期81例非老年SAP患者（非老年组）的病因、临床表现、并存疾病、并发症及病死率等资料进行对比研究。结果老年SAP最常见病因为胆源性，多伴其他慢性疾病，老年患者腹痛和发热的发生率分别为55．36％和64．29％，均低于非老年组的83．95％和86．42％（P＜0．01）；老年患者的多器官功能障碍及休克发生率分别为39．29％和32．14％，显著高于非老年组的6．17％和13．58％（ P ＜0．01），而局部并发症与非老年组无明显差异；老年患者平均住院（25．2±13．4） d，较非老年组（16．1±7．3） d明显延长（P＜0．01），病死率14．29％高于非老年组的1．32％（P ＜0．05）。结论老年SAP以胆源性胰腺炎为主，临床症状无特异性，伴发疾病多，多器官功能障碍发生率较高。治疗上遵循多学科参与，以非手术治疗为主的综合治疗体系，在适时、适当的时候进行外科干预。
目的：探討老年重癥急性胰腺炎（ SAP）的髮病特點及治療策略。方法迴顧性分析2005年12月至2012年12月天津市武清區人民醫院收治的56例老年SAP患者（老年組）的臨床資料，併與同期81例非老年SAP患者（非老年組）的病因、臨床錶現、併存疾病、併髮癥及病死率等資料進行對比研究。結果老年SAP最常見病因為膽源性，多伴其他慢性疾病，老年患者腹痛和髮熱的髮生率分彆為55．36％和64．29％，均低于非老年組的83．95％和86．42％（P＜0．01）；老年患者的多器官功能障礙及休剋髮生率分彆為39．29％和32．14％，顯著高于非老年組的6．17％和13．58％（ P ＜0．01），而跼部併髮癥與非老年組無明顯差異；老年患者平均住院（25．2±13．4） d，較非老年組（16．1±7．3） d明顯延長（P＜0．01），病死率14．29％高于非老年組的1．32％（P ＜0．05）。結論老年SAP以膽源性胰腺炎為主，臨床癥狀無特異性，伴髮疾病多，多器官功能障礙髮生率較高。治療上遵循多學科參與，以非手術治療為主的綜閤治療體繫，在適時、適噹的時候進行外科榦預。
목적：탐토노년중증급성이선염（ SAP）적발병특점급치료책략。방법회고성분석2005년12월지2012년12월천진시무청구인민의원수치적56례노년SAP환자（노년조）적림상자료，병여동기81례비노년SAP환자（비노년조）적병인、림상표현、병존질병、병발증급병사솔등자료진행대비연구。결과노년SAP최상견병인위담원성，다반기타만성질병，노년환자복통화발열적발생솔분별위55．36％화64．29％，균저우비노년조적83．95％화86．42％（P＜0．01）；노년환자적다기관공능장애급휴극발생솔분별위39．29％화32．14％，현저고우비노년조적6．17％화13．58％（ P ＜0．01），이국부병발증여비노년조무명현차이；노년환자평균주원（25．2±13．4） d，교비노년조（16．1±7．3） d명현연장（P＜0．01），병사솔14．29％고우비노년조적1．32％（P ＜0．05）。결론노년SAP이담원성이선염위주，림상증상무특이성，반발질병다，다기관공능장애발생솔교고。치료상준순다학과삼여，이비수술치료위주적종합치료체계，재괄시、괄당적시후진행외과간예。
Objective To investigate the clinical characteristics and therapeutic strategy of senile severe acute pancreatitis(SAP).Methods A total of 56 cases of elderly patients with SAP admitted in Wuqing People′s Hospital from Dec.2005 to Dec.2012 were selected as the elderly group,another 81 cases of non-elderly patients with SAP admitted in the hospital during the same period were selected as the non-elderly group.The clinical data of patients in the two groups were retrospectively analyzed,and the etiology,clinical characteristics,coexisting diseases, local complications and systemic complications , as well as the mortality rates of the two groups were compared.Results The most common causes of SAP in elderly patients were biliary etiologies,and many of the cases were associated with other chronic diseases.In the elderly group,the incidence rates of abdominal pain and fever were 55.36% and 64.29%,lower than 83.95% and 86.42%of non-elderly group(P<0.01);incidence rates of multiple organ dysfunction syndrome(MODS) and shock of the elderly group were 39.29% and 32.14%,significantly higher than 6.17% and 13.58% of non-elder-ly group(P <0.01),while there were no statistically significant differences of the local complications betweenthe two groups.The average hospital stay of the elderly group was (25.2 ±13.4) days,significantly longer than (16.1 ±7.3) days of non-elderly group(P<0.01);and the mortality of the elderly group was 14.29%,higher than 1.32% of non-elderly group(P<0.05).Conclusion The most common type of SAP in elderly patients is acute biliary pancreatitis.Senile SAP has no specific clinical symptoms,but has many concomitant diseases and high incidence of MODS.Therefore,treatment for senile SAP should be based on the multi-disciplinary,comprehensive treatment system which mainly includes the non-surgical therapy with limited surgical intervention in appropriate timing .
