暴发性重症急性胰腺炎临床特点及治疗方法的探讨

目的 认识暴发性重症急性胰腺炎(fulminant severe acute pancreatitis，FSAP)的特点，探讨其治疗方法。方法 统计出现症状72h内住院的重症胰腺炎(severe acute pancreatitis，SAP)病人209人，回顾性的整理、分析暴发性重症胰腺炎发生、发展的特点。暴发性重症急性胰腺炎定义为，出现症状72h内发生器官衰竭的重症胰腺炎。56例病人为暴发性重症胰腺炎组(FSAP组)。153例72h内末发生器官衰竭的病人组成重症胰腺炎组(SAP组)。结果 FSAP死亡率、低氧血症和多器官系统衰竭发生率明显高于SAP组(53．6％vs2．6％，85．71％vs22．88％和78．6％vs41．2％)。Logistic回归分析FSAP高危因素为：高APACHE—Ⅱ评分，低氧血症。结论 我们提出FSAP的特征为：多器官系统衰竭、胰腺病变重、早期发生低氧血症、早期腹腔高压征(intro-abdominal hypertension,LAH)和高APACHE—Ⅱ评分。FSAP的预后差。积极纠正低氧血症、微创治疗等手段可能对FSAP治疗有益。

A discussion of clinical characteristics and management of fulminant severe acute pancreatitis

Objective To discuss clinical characteristics and management of fulminant severe acute pancreatitis (FSAP). Methods The clinical data of 209 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 hours after onset of symptoms were retrospectively analyzed to determine the occurrence and development of FSAP. FSAP was defined as presence of organ failure (OF) at admission. Fifty-six patients had FSAP and the other 153 without OF had SAP. Results FSAP had higher mortality and incidence of hypoxemia and multi-organ failure than SAP (53.6% vs 2.6%, 85.71% vs 22.88%, 78.6% vs 41.2%, respectively). Logistic regression analysis revealed that the major risk factors for FSAP were higher APACHE II and hypoxemia. Conclusions FSAP is characterized by multi-organ failure, severe pancreatic pathological changes, early hypoxemia and intro-abdominal hypertension and higher APACHE II. Patients with FSAP have poor prognosis. Current therapeutic methods for FSAP should be further studied so as to improve the curative rate. Such therapeutic approaches as mini-trauma management and hypoxemia healing etc. may be useful for treatment of FSAP.