重症急性胰腺炎早期低白蛋白血症的临床研究

目的:探讨重症急性胰腺炎(severe acute pancreatitis, SAP)早期低白蛋白血症的发生机制和临床特点,及其对预后的影响和防治措施.方法:2003年8月1日～2004年12月31日收治的SAP早期并发低白蛋白血症患者138例,分成轻度低白蛋白血症组(血浆白蛋白30～35 g/L)54例和重度低白蛋白血症组(血浆白蛋白＜30 g/L)84例,比较分析两组的早期并发症、相关参数、后期感染及病死率.结果:重度低白蛋白血症组肾功能衰竭、休克、心衰及消化道出血的发生率高于轻度低白蛋白血症组(P＜0.01),肝功能衰竭发生率两组比较无统计学差异;Ranson评分及Balthazar CT评分两组间比较,差异无统计学意义(P＞0.05);重度低白蛋白血症组的急性生理和慢性健康评价指标Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)评分、脉搏和呼吸频率均明显高于轻度低白蛋白血症组(P＜0.05或P＜0.01);重度低白蛋白血症组后期感染发生率及病死率均高于轻度低白蛋白血症组(P＜0.01).结论:SAP早期低白蛋白血症对SAP的病理生理过程起着促进作用,血浆白蛋白水平越低,则并发症越多,后期感染发生率及病死率也越高.减轻SAP早期的炎性反应,及时足量补充白蛋白、氨基酸及脂肪等营养物质,是防止低白蛋白血症发生和发展的关键.

Clinical study on severe acute pancreatitis associated with hypoalbuminemia in early stage

OBJECTIVE: To investigate the occurring mechanism and clinical characteristics of severe acute pancreatitis (SAP) associated with hypoalbuminemia in early stage and its influence on prognosis of SAP and the preventive and therapeutic management of this disease. METHODS: One hundred and thirty-eight cases diagnosed as SAP complicated by hypoalbuminemia in early stage were accepted in our hospital from August 1, 2003 to December 31, 2004, and they were divided into 2 groups according to the level of plasma albumin: mild hypoalbuminemia (30 to 35 g/L) group and severe hypoalbuminemia (<30 g/L) group. The complications in the early stage, related parameters, and the incidence rate of infection and mortality in the later stage were evaluated respectively. RESULTS: The incidence rates of renal dysfunction, shock, cardiovascular failure and gastrointestinal hemorrhage, the score of acute physiology and chronic health evaluation II (APACHE II ) and the frequencies of pulse and breath in the severe hypoalbuminemia group were all higher than those in the mild hypoalbuminemia group (P<0.05 or P<0.01). The differences of incidence rate of hepatic failure and the scores of Ranson and Balthazar CT between these two groups had no statistical significance (P>0.05). The incidence rate of infection and the mortality in the severe hypoalbuminemia group were higher than those in the mild hypoalbuminemia group (P<0.01) in the later stage of SAP. CONCLUSION: Hypoalbuminemia in the early stage can accelerate the deterioration in pathophysiology of SAP. The lower level of the plasma albumin is in the early stage, the more complications and the higher incidence rate of infection and mortality will be in the later stage. To relieve the extent of systemic inflammatory response syndrome (SIRS) and abundant supplement of albumin, amino acid and lipid in time may be crucial to prevent the occurrence and deterioration of hypoalbuminemia.