儿童重症急性胰腺炎的特点与治疗

儿童急性胰腺炎病因主要包括感染、药物诱导、外伤和先天性胆道畸形等.儿童胰腺炎发病率低于成人,但呈增多趋势,至今儿童重症急性胰腺炎(severe acute pancreatitis,SAP)仍鲜有资料可循.腹痛和呕吐是SAP早期主要症状,也可能以休克或多器官功能障碍起病.目前仍没有适合儿童SAP病情严重程度的评分标准,有限资料认为入院24h血液脂肪酶升高程度、白蛋白水平和WBC计数有助于病情和预后的判断.血液净化可以有效减轻炎症反应、改善器官功能和稳定液体平衡,可能是儿童SAP新的有潜力的治疗措施.     

小儿重症急性胰腺炎的治疗

目的探讨小儿重症急性胰腺炎的综合治疗方案。方法对收治的1例小儿重症急性胰腺炎患儿进行治疗并总结其疗效。结果经采用抑制胰腺外分泌、抗感染、营养支持、中药治疗,并给予持续血液净化,患儿获得痊愈。结论小儿重症急性胰腺炎的治疗为个体化的综合治疗,持续血液净化可能提高抢救存活率,营养支持和中医治疗也是治疗的重要环节。     

儿童重症急性胰腺炎的诊治进展

儿童重症急性胰腺炎的发病率较低,起病急骤凶险,且症状不典型,有些症状缺乏特异性,病死率相对较高.本文将对重症急性胰腺炎的诊断、治疗进展作一综述.     

急性重症胰腺炎的诊断进展

急性胰腺炎,在临床上根据其严重程度,可分为轻型和重型两大类,前者在诊断和治疗上均无困难。一般疗程1～2周,病员多于1月内恢复,胃肠胰功能亦恢复正常。重型又称急性重症胰腺炎,习惯上常称急性出血环死型胰腺炎(AHNP)。但根据我院张圣道等报道139例重症病人手术时取材资料作病理检查示59.71％属坏死型.23.02％属出血坏死型,9.35％为脓肿型及3.60％为坏疽型_~[1],故以急性坏死型胰腺炎(ANP)称之似较更妥。过去一般认为急性重症胰腺炎(ASP)的病变总是弥漫性胰腺受累,张氏的手术发现,头体尾均受累者占54.4％,其次为体尾占25.7％,少数仅累及体部(5.9％),头部(5.14％),头体部(5.14％)及尾部(3.7％)。了解这一情况对正确理解ASP的影像学发现以及作出正确诊断非常重要。临床上常见的急性胰腺炎,多数为轻型,即单纯水肿型.重型者属较少见.其发生率约     

小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

目的通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中A组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C组为化脓性阑尾炎未穿孔,B组行腹腔镜阑尾切除+腹腔引流术,C组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E组为坏疽穿孔性阑尾炎,D组行腹腔镜阑尾切除+腹腔引流术,E组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后舡门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。     

小儿急性重症胰腺炎13例

我院1983年～1994年共收治小儿急性重症胰腺炎13例。报道如下。临床资料13例急性重症胰腺炎，男5例，女8例。5～7岁4例，8～14岁9例。入院时均有腹痛、腹胀、呕吐、发热。弥漫性腹膜炎体征12例，休克5例。血白细胞＞15X109／L8例，血、尿淀粉酶升高各13例。B超显示胰腺明显肿大     

儿童重症急性胰腺炎一例

患儿,男,12岁,体质量80kg,急性起病,因＂阵发性腹痛伴间断呕吐1 d＂入院.患儿于入院当日晨起出现上腹痛,为阵发性剧痛,恶心、呕吐（胃内容物）2次,里急后重,腹痛逐渐加重.     

儿童重症监护病房收治急性胰腺炎的临床特征与预后分析

目的:了解儿童重症监护病房收治急性胰腺炎的临床特征与预后。方法:回顾性总结2016年7月至2021年6月上海交通大学附属儿童医院重症医学科(PICU)收治的急性胰腺炎患儿的资料,包括病因、临床特点、影像学特点、并发症和结局。结果:同期PICU收治急性胰腺炎患儿47例(男24例,女23例),发病月龄84(48,144)个...     

小儿急性出血坏死性胰腺炎的治疗

６例小儿急性出血坏死性胰腺炎，经手术治疗，治愈５例，死亡１例。对其降低死亡率、严格控制禁食时间、营养支持、腹腔引流及灌洗、“三造瘘”等问题加以讨论。     

急性重症胰腺炎的治疗进展

急性重症胰腺炎(ANP)的诊断一旦确立后就应外科手术治疗还是内科治疗?这争论已持续摇摆多年。现在的看法是“综合治疗体系”。有条件者危重病人的抢救应在ICU中进行。 一、目前外科治疗的现状 目前的看法,胰腺坏死未感染的病人作非手术治疗,成功率高达85％以上,对坏死有感染者经积极治疗而病情继续恶化者立即手术,否则尽可能作后期手术,待感染病变局限后达到一次引流手术获得痊愈。对“阻塞性胆源性胰腺炎”及“胰腺脓肿穿破致腹膜炎”者应立即手术。在抢救中多学科参与的综合治疗措施尤为重     

小儿重症哮喘的治疗

重症哮喘(severe asthma)患儿在临床上较为常见。由于严重的支气管痉挛、黏液过度分泌和气道炎症、水肿等影响,如不及时治疗可发展至呼吸衰竭甚至死亡,是临床急症之一。重症哮喘在全球仍是收入PICU患儿的常见疾病,并仍然有很高的病死率。有资料报道,美国15岁以下哮喘患儿病死率从1979年的1·2/10万上升至1995年的2·1/10万。我国目前尚无全国性流行病学调查数据。高度重视、早期确诊、恰当治疗、减少并发症是降低病死率的关键[1]。1避开哮喘发作诱因哮喘的发作起始于各类诱发因素的刺激,而发作后诱发因素的持续接触,能增高气道对其他变应…     

短时静-静脉血液滤过在小儿重症急性胰腺炎治疗中的应用

目的 探讨短时静-静脉血液滤过(SVVH)在小儿重症急性胰腺炎治疗中的策略和疗效.方法 将我院2006年5月至2010年5月收治的27例小儿重症急性胰腺炎患儿按治疗方法分为常规治疗组(A组)和常规治疗+SVVH组(B组),对其血液滤过参数、临床疗效、并发症和住院费用进行统计分析.结果 治疗后3 d与治疗前相比,在A组内,WBC(20.5±3.8)×109/L比(14.3±2.7)×109/L、AMS(781.6±187.5)U/L比(603.2±113.1)U/L、BUN(11.1±2.7)mmol/L比(8.4±1.8)mmol/L、CRP(294.5±37.7)mg/L比(171.5±34.5)mg/L、血Ca2+(1.6±0.4)mmol/L比(2.2±0.2)mmol/L、Na+浓度(128.0±6.0)mmol/L比(137.1±2.9)mmol/L及PaO2(73.9±12.1)mmHg比(85.2±5.3)mmHg等方面差异具有统计学意义(P＜0.01),UAMY(2606.9±963.9)U/L比(1782.2±878.0)U/L的差异具有统计学意义(P＜0.05);在B组内,WBC(20.1±4.8)×109/L比(9.4±3.2)×109/L、AMS(815.8±186.9)U/L比(280.1±93.9)U/L、UAMY(2706.1±961.2)U/L比(948.2±719.7)U/L、BUN(11.3±1.7)mmol/L比(5.2±2.4)mmol/L、CRP(301.9±48.7)mg/L比(87.3±34.2)mg/L、血Ca2+(1.8±0.4)mmol/L比(2.3±0.1)mmol/L、Na+浓度(127.0±6.7)mmol/L比(140.3±3.0)mmol/L及PaO2(74.7±10.4)mmHg比(93.3±5.7)mmHg,差异均有统计学意义(P＜0.01),K+(5.5±1.5)mmol/L比(4.5±0.6)mmol/L的差异具有统计学意义(P＜0.05);两组间在治疗后3 d相比,WBC(14.3±2.7)×109/L比(9.4±3.2)×109/L、AMS(603.2±113.1)U/L比(280.1±93.9)U/L、BUN(8.4±1.8)mmol/L比(5.2±2.4)mmol/L及CRP(171.5±34.5)mg/L比(87.3±34.2)mg/L,差异具有统计学意义(P＜0.01),在血UAMY(1782.2±878.0)U/L比(948.2±719.7)U/L、Ca2+(2.2±0.2)mmol/L比(2.3±0.1)mmol/L、Na+浓度(137.1±2.9)mmol/L比(140.3±3.0)mmol/L和PaO2(85.2±5.3)mmHg比(93.3±5.7)mmHg间的差异具有统计学意义(P＜0.05),而血K+浓度(4.9±1.0)mmol/L比(4.5±0.6)mmol/L的差异无统计学意义(P＞0.05).两组在腹痛缓解时间、AMS恢复正常时间、住院天数和住院费用上差异有统计学意义(P＜0.01),治疗效果、治疗3 d后John评分上的差异也有统计学意义(P＜0.05).结论 药物联合早期SVVH治疗小儿急性胰腺炎效果满意.

Abstract：

Objective To review the strategy and therapeutic effect of short term venous-venous hemofiltration (SVVH) in the treatment of severe acute pancreatitis (SAP) in children. Methods Thirty-nine children with SAP hospitalized between May 2006 and May 2010, were treated with two therapeutic strategies; routine management (Group A) and routine combined with SVVH treatment (Group B). The biochemical indicators, clinical effects, complications, cost and hospitalization duration were analyzed retrospectively. Results Comparing the data at the onset with those after threedays therapy, the biochemical indicators including WBC counts, AMS, UAMY, BUN, CRP, Ca2+ ,Na+ and PaO2 significantly improved in group A (P＜0. 01). In group B, all the biochemical indicators (WBC Counts, AMS, UAMY, BUN, CRP, Ca2+ , K+ , Na+ , PaO2 ) showed statistically significant differences (P＜0.05). Between the two groups, some of the day 3 results, including WBC,AMS, CRP, showed significant differences(P＜0.01). The level of UAMY, Ca2+, Na+ and PaO2also showed statisticcal differences (P＜0. 05), but there were no difference in K+ (P＞0. 05). With respect to the disappearance of abdominal pain and return to normal of AMS, the cost and hospitalization, the differences between the two groups was significant (P＜0. 01) Treatment effects and John's scoring on day 3 also demonstrated statistically significant differences (P＜0. 05). Conclusions The strategy of routine combined with SVVH is a viable treatment for severe acute pancreatitis of children.     

L-asparaginase-induced severe necrotizing pancreatitis successfully treated with percutaneous drainage

L-asparaginase is a key component of the antileukemic therapy in children with acute lymphoblastic leukemia (ALL). Pancreatitis has been noted to be a complication in 2-16% of patients undergoing treatment with L-asparaginase for a variety of pediatric neoplasms. Most cases of pancreatitis associated with L-asparaginase toxicity are self-limiting and respond favorably to nasogastric decompression and intravenous hyperalimentation. However, in rare instances, hemorrhagic pancreatitis or necrosis may occur. L-asparaginase-induced pancreatitis is an uncommon but potential lethal complication of the treatment of leukemia. We present a pediatric patient with leukemia and a severe, L-asparaginase-induced necrotizing pancreatitis, treated successfully with percutaneous drainage used to flush the infected necrotic parts.     

胸腔灌洗、负压吸引治疗小儿急性脓胸16例分析

小儿脓胸大多数继发于肺部感染,若就诊不及时、脓液黏稠、引流效果差易形成包裹性脓胸,最终形成慢性脓胸,需要开胸行纤维板剥除术,严重者导致胸廓畸形.我院自2007年9月至2008年9月收治16例小儿急性脓胸,采用胸腔灌洗、持续负压吸引的方法治疗,获得满意效果,现报告如下.     

Severity scores in children with acute pancreatitis

ABSTRACT: Severity scores are used to predict the outcome of acute pancreatitis (AP). Several scores are used in adult patients, but none has been thoroughly validated for specific use in paediatric patients. We retrospectively collected data from 48 children with AP (13 severe and 35 mild). The main causes were trauma (23%), idiopathic (23%), lithiasis (12.5%), and virus (10.5%). We evaluated 3 clinical scores (Ranson, Glasgow modified, and DeBanto) and Balthazar computed tomography severity index. The clinical scores had a good specificity (approximately 85%) but a low sensitivity (approximately 55%) in predicting the severity of paediatric AP. The radiological score is better (sensitivity 80%, specificity 86%). The area under the receiver operator characteristic curve was 0.699 (95% CI 0.508%-0.891%, P?=?0.054) for the DeBanto score, 0.846 (95% CI 0.69%-1%, P?=?0.001) for the Ranson score, and 0.774 (95% CI 0.584%-0.964%, P?=?0.008) for the Glasgow and 0.898 (95% CI 0.73%-1%, P?=?0.011) for the Balthazar computed tomography severity index score. In our paediatric cohort, the severity of AP was best predicted by Balthazar computed tomography-based scoring scale. Our results confirm previously reported low sensitivity of adult-based clinical scoring scales.     

儿童腹膜透析相关性腹膜炎的治疗进展

腹膜炎是腹膜透析患儿最常见和最严重的并发症之一,可以造成腹膜透析技术的失败、腹膜清除功能下降和腹膜硬化,最终导致患儿退出腹膜透析,从而影响到腹膜透析的预后.全面了解儿童腹膜透析相关性腹膜炎的好发原因和最新的治疗进展,对有效治疗腹膜炎、预防腹膜炎的发生、保护腹膜功能及维持腹膜透析具有重要的意义.