重症急性胰腺炎早期脏器功能不全持续时间与治疗对策

目的探讨重症急性胰腺炎（severe acute pancreatitis,SAP）影响脏器功能不全持续时间的因素及其对患者转归的作用以及相应的治疗策略。方法2000年1月至2005年6月连续收治74例Ⅱ型SAP患者,按脏器功能不全持续时间分为两组：脏器功能不全持续时间≤3d,为暂时性脏器功能不全组（20例）;脏器功能不全持续时间〉3d,为持续性脏器功能不全组（54例）。比较两组患者在SAP并发症和病死率方面的差异。结果74例SAPⅡ型患者中,心血管系统功能不全发生率80％、肺脏47％、肝脏37％、肾脏20％;暂时性脏器功能不全组多脏器功能不全所占比例明显低于持续性脏器功能不全组（P〈0．01）。暂时陛脏器功能不全组并发症发生率和病死率明显低于持续性脏器功能不全组（P值分别为0．038和0．054）。结论脏器功能不全持续存在3d以上是预示SAP患者死亡的危险因素,避免脏器功能不全发生或缩短脏器功能不全的持续时间是改善SAP患者预后的关键。

Effects of duration of early organ dysfunction and therapeutic strategy on outcomes in patients with severe acute pancreatitis

OBJECTIVE: To investigate the characteristics of early organ dysfunction in patients with severe acute pancreatitis (SAP) and therapeutic regimens. METHODS: A total of consecutive 74 patients with a confirmed diagnosis of SAP admitted between January 2000 and June 2005 were divided into two groups, transient group (72 h, n = 54). The differences in local complications and mortality were compared between the two groups. RESULTS: Among the seventy-four SAP patients, the incidence rate of cardiovascular dysfunction was 80%, respiratory dysfunction 47%, hepatic dysfunction 37% and renal dysfunction 20%. The incidence of multiple organ dysfunction in transient group was much lower than that in persistent group (P < 0.01). The local complications and death in transient group patients were less than that in persistent group (P = 0.038, P = 0.054, respectively), irrespective of onset of organ dysfunction on admission or later during the first week. CONCLUSIONS: The important determinant of risk of death from SAP is the persistence of early organ dysfunction for more than 72 h. Consequently, aggressively ameliorating the blood perfusion and the oxygenation in tissue is the priority in reducing organ dysfunction or shortening the duration of organ dysfunction.