尿胰蛋白酶原-2血清脂肪酶及Uamy/Ucr比值对急性胰腺炎的诊断价值

目的:探讨尿淀粉酶/尿肌酐(Uamy/Ucr)比值及尿胰蛋白酶原-2(urine trypsinogen-2)血清脂肪酶(LPS)的测定对急性胰腺炎(AP)的临床诊断价值.方法:对158例急腹症患者进行血清淀粉酶(Samy)、尿淀粉酶(Uamy)、Uamy/Ucr及尿胰蛋白酶原-2(Try-2),血清脂肪酶(LPS)测定.结果:45例急性胰腺炎尿胰蛋白酶原-2和Uamy/Ucr比值进行联合诊断的敏感性、特异性最高,分别为97.13％和98.00％;尿胰蛋白酶原-2检测的敏感性为95.56％,特异性为94.69％；Uamy/Ucr比值的敏感性为93.33％,特异性为93.81％;血清脂肪酶为88.89％、73.45％ ;Samy敏感性为80.00％,特异性为79.64％；Uamy的敏感性为77.78％,特异性为78.76％.结论:Uamy/Ucr比值及尿胰蛋白酶原-2是较好的早期诊断急性胰腺炎的指标.     

血、尿胰蛋白酶原激活肽对急性胰腺炎的诊断及严重程度判断价值

目的结合CT扫描结果,探讨血、尿胰蛋白酶原激活肽（TAP）对急性胰腺炎的早期诊断和严重程度判断的价值。方法65例急性胰腺炎患者按CT结果分为轻症急性胰腺炎（MAP）组42例和重症急性胰腺炎（SAP）组23例,取29例同期非胰腺炎的急腹症患者作为对照组。分别测定所有患者血、尿TAP。结果在入院后6、12、24h,SAP组血TAP浓度〉9．0nmol／L,MAP组血TAP浓度〈3．5nmol／L,SAP组与MAP组、对照组比较差异有统计学意义（P〈0．05）;在入院后6、12、24h,SAP组尿TAP中位浓度（102．8、78．2、52．3nmol/L）显著高于MAP组（32．5、28．7、25.6nmol／L）及对照组（12．6、12．2、11．5nmol／L）,差异有统计学意义（P〈0．05）;在入院后3、5d各组间血、尿TAP浓度比较差异无统计学意义（P〉0．05）。结论早期动态监测血、尿TAP具有较高诊断及预测价值,有利于急性胰腺炎的早期诊治。     

急性胰腺炎患者尿中胰蛋白酶原激活肽水平的变化

目的 观察急性胰腺炎（AP）患者尿中胰蛋白酶原激活肽（TAP）水平的动态变化及与疾病严重度的关系。方法 出现首发症状后48h内入院的AP患者57例及对照组患者11例，运用酶联免疫吸附试验检测入院时，24，48及72h尿样TAP浓度，并观察患者严重度。结果 入院时，24,48h重症组尿TAP值显著高于轻型组及对照组72h各组间差异无显著性。轻型组与对照组各时相均无显著性差异。重症组入院时尿TAP值最高，后逐渐下降。结论 AP患者早期胰腺间质和血中胰蛋白酶原的暴发激活可能是重症急性胰腺炎发病的中心环节。     

尿中胰蛋白酶原激活肽对重症急性胰腺炎的早期预测价值

目的　评估尿中胰蛋白酶原激活肽（TAP）对重症急性胰腺炎（SAP）患者的早期预测价值。方法　出现首发症状后48h内入院的急性胰腺炎（AP）患者41例（轻型29例、重症12例）及对照组11例,在入院时、24h、48h及72h取尿样测定TAP浓度,同时对每个患者在入院后48h进行APACHEⅡ评分。结果　入院时重症组尿TAP值（95nmol/L)高于轻型组（20nmol/L,P＜0.005)及对照组(15nmol/L,P＜0.005)。入院时尿中TAP值≥35nmol/L预测SAP的特异性和敏感性分别为89.7%和91.7%,而APACHEⅡ≥9诊断SAP的特异性和敏感性仅为72.7%和75.0%。90%的患者可通过TAP预测AP的严重程度,而APACHEⅡ评分仅能对73%的患者进行正确评价。结论　首发症状出现后48h内入院的AP患者尿中TAP浓度可早期预测SAP。     

血清淀粉酶、C反应蛋白、降钙素原与尿胰蛋白酶原激活肽联合检测对急性胰腺炎的诊断价值

目的:探讨血清淀粉酶(S-Amy)、C反应蛋白(CRP)、降钙素原(PCT)及尿胰蛋白酶原激活肽(TAP)联合检测对急性胰腺炎(AP)的诊断价值。方法:选取收治的120例AP患者(AP组)与90例健康自愿者(对照组),检测并比较两组研究对象以及不同病情AP患者间S-Amy、CRP、PCT、TAP的水平,采用受试者工作曲线(ROC)分析血清S-Amy、CRP、PCT、TAP单独与联合检测对AP的诊断能力。结果:S-Amy、CRP、PCT、TAP水平在AP组均高于对照组,在重症患者(SAP)均高于轻症患者(MAP),差异均有统计学意义(均P0.05)。4项联合检测诊断AP的灵敏度为97.28%、特异度为84.13%、漏诊率为2.72%、误诊率为15.87、ROC曲线下面积值为0.905。结论:S-Amy、CRP、PCT与尿TAP联合检测对早期诊断AP具有一定的实用价值,可以作为临床参考。     

胰蛋白酶原激活肽对重症急性胰腺炎早期临床诊断价值及与预后的关系

目的探讨胰蛋白酶原激活肽(TAP)对重症急性胰腺炎的早期诊断价值,并观察TAP与重症急性胰腺炎患者预后的关系。方法收集胰腺炎患者89例,其中重症急性胰腺炎患者45例,轻症急性胰腺炎患者44例,32例排除胰腺炎的急腹症患者作为对照组;所有患者在入院6 h内采集血液使用ELISA试剂盒检查TAP值,同时观察胰腺炎患者中出现并发症的例数;采用ROC曲线分析TAP对胰腺炎的诊断价值,同时分析对轻症急性胰腺炎及其并发症的判别价值。结果 3组患者的TAP值比较差异有统计学意义(P0.01),以重症急性胰腺炎患者值最大;ROC曲线分析显示,以TAP值2.78 nmol/L作为判别标准,TAP诊断胰腺炎的灵敏度为88.8%、特异性为100%、准确性为91.7%;以TAP值8.55 nmol/L作为判别轻症与重症急性胰腺炎,灵敏度为92.9%、特异性为95.2%、准确性为88.7%;以TAP值11.20 nmol/L作为并发症的判别,灵敏度为75.0%、特异性为90.4%、准确性为82.2%。结论 TAP在早期可用于诊断胰腺炎,尤其对诊断重症急性胰腺炎具有重要的价值,同时TAP还可用于评价重症急性胰腺炎患者的预后。     

胰蛋白酶原激活肽在大鼠实验性急性胰腺炎中的产生及意义

目的探讨大鼠实验性急性胰腺炎(AP)模型中胰蛋白酶原激活肽(TAP)的产生及意义.方法将90只SD大鼠随机分为5组EP组(3%牛磺胆酸钠逆行胆胰管注射组);NP组(5%牛磺胆酸钠逆行胆胰管注射组);TP组(3%牛磺胆酸钠逆行胆胰管注射后半小时经股静脉注入乌司他丁组);CP组(0.9%生理盐水逆行胆胰管注射组);OP组(假手术组).分别于制模后3、6及24小时后处死动物,取血测定血淀粉酶和TAP水平,同时取胰腺标本观察其组织病理学改变并评分.结果NP组胰腺病变明显重于EP组.制模后3小时和6小时血浆TAP水平NP组分别为(4.798±0.169)nmol/L和(3.999±0.299)nmol/L,明显高于EP组的(2.416±0.148)nmol/L和(3.356±0.211)nmol/L;在制模6小时后TP组血浆TAP水平为(1.611±0.113)nmol/L,比EP组的(3.356±0.211)nmol/L明显降低.EP组与NP组血浆TAP水平差异的出现早于两组间胰腺组织病理学改变差异的出现.结论血浆TAP水平与大鼠实验性AP的严重程度有关.血浆TAP水平可以作为早期预测实验性AP严重程度的指标.     

急性胰腺炎患者血浆胰蛋白酶原激活肽水平与急性胰腺炎关系的研究

急性胰腺炎是常见腹部疾病,其中20%病例将发展成重症急性胰腺炎,在紧急情况下,其严重度分级常是一个问题。胰蛋白酶原激活后形成的胰蛋白酶原激活肽(TAP)与急性胰腺炎病情恶化有关。本研究旨在探讨血浆中TAP与急性胰腺炎的关系。资料和方法本组急性胰腺炎患者85例,对照组为42例非胰腺炎患者。在85例急性胰腺炎患者中68例为轻型,17例为重型,男性54例,女性31例;年龄24～65岁,平均年龄44.5岁。胰腺炎的病因为胆源性26例,酒精性46例,其他13例。根据日本1990年制定的临床诊断标准[1]:①上腹部急性发作性腹痛。②血、尿或腹水中胰酶升高。③影…     

Acute Abdominal Pain in Patients with Systemic Lupus Erythematosus

Background  Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. Methods  We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. Results  Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001). Conclusion  This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these ethiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.     

腹腔镜技术在外科急腹症中的应用

目的探讨腹腔镜技术在外科急腹症中的应用价值。方法2002年3月～2007年3月,行306例急诊腹腔镜手术探查与相应治疗。术前诊断急性阑尾炎105例,腹痛原因待查34例,急性胆囊炎、胆囊结石64例,消化道穿孔51例,胆总管结石、急性胆管炎5例,肠梗阻33例,有明确外伤史9例,重症急性胰腺炎5例。结果本组306例全部术中明确诊断,腹腔镜手术成功275例,其中阑尾切除术123例,胆囊切除术57例,消化道穿孔修补术48例,22例肠梗阻中行肠粘连松解13例、小肠复位联合斜疝修补4例、腹腔镜辅助下乙状结肠癌根治直肠前吻合4例、小切口小肠肠段切除端端吻合术1例,胆总管切开取石T管引流术3例,右叶肝破裂修补术2例,脾破裂止血3例,重症急性胰腺炎清创冲洗引流术5例,腹腔镜探查12例（肠系膜挫裂伤2例,腹壁刀刺伤伴大网膜挫伤1例,原发性腹膜炎8例,过敏性紫癜腹型1例）;余31例腹腔镜完成困难而中转开腹。306例随访1～18个月,无术中、术后并发症。结论急诊腹腔镜探查术不仅可以对病因不明的急腹症做出准确诊断,且可同时行腹腔镜手术治疗。即使腹腔镜下不能完成的手术,也可以指导及时开腹,以及采取较为合适的手术切口。     

自发性食管破裂急腹症表现的原因探讨

自发性食管破裂因其急腹症的表现，常常被延误诊治。我院1986～2001年共收治自发性食管破裂病人12例．其中7例有急腹症表现，现结合文献对其原因进行探讨。     

Standard Outpatient Re-Evaluation for Patients Not Admitted to the Hospital After Emergency Department Evaluation for Acute Abdominal Pain

Background  

The aim of the present study was to investigate the efficacy and safety of standard outpatient re-evaluation for patients who are not admitted to the hospital after emergency department surgical consultation for acute abdominal pain.     

Sensitivity and Specificity of Red Cell Distribution Width in Diagnosing Acute Mesenteric Ischemia in Patients with Abdominal Pain

Background

We investigated the utility of the red cell distribution width (RDW) in diagnosing acute mesenteric ischemia (AMI) in patients with abdominal pain.

Methods

The patients were divided into two groups in this retrospective case–control study: patients with AMI and patients with abdominal pain who did not require urgent surgery. Venous blood was collected from the patients upon admission to the emergency department, and abdominal computed tomography angiography was performed. The RDW and hematological and biochemical parameters of the groups were compared. The primary outcome was AMI among the patients with abdominal pain. The secondary outcome was mortality, complaint period, and size of ischemia/necrosis among the AMI patients.

Results

The RDW, white blood cell lactate dehydrogenase, and blood urea nitrogen of the patients with AMI were significantly different from those of the control group. When the average RDW (15.04 %) of the patients with AMI was used as a cut-off value, the sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood (?LR) were 40.8 %, 81.2 %, 2.17, and 0.73, respectively. When patients with AMI and anemia were included in the group, the sensitivity and specificity values did not change. There was no relation between the RDW and mortality, size of the ischemia/necrosis, and complaint period. Furthermore, there was no significant difference in the average RDW between the patients with ischemia/necrosis in the small intestine only and those with ischemia/necrosis in the colon.

Conclusion

The RDW on admission is of marginal help to diagnose AMI among patients with abdominal pain.     

Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning

Background Acute abdominal pain is a common diagnostic problem. This study aimed to evaluate the routinely use of contrast enhanced computed tomographic (CT) scanning early in the diagnostic process. Methods A retrospective review of 2,222 patients with acute abdominal pain who underwent contrast enhanced CT scanning within 24 h after admission. The diagnoses obtained were compared with the final diagnoses after 1 month. Results After CT scanning the following diagnoses were suggested as the primary cause of the abdominal pain: nonspecific abdominal pain 984 (44.3%), appendicitis 354 (15.9%), bowel obstruction 190 (8.6%), diverticulitis 182 (8.2%), gastrointestinal perforation 52 (2.3%), gallstone disease 64 (2.9%), pancreatitis 72 (3.2%), inflammatory bowel disease 13 (0.6%), intra-abdominal malignancy 34 (1.5%), vascular disease (including 1 completely cured patient with paradoxical embolization in the superior mesenteric artery) 33 (1.5%), urological 131 (5.9%), gynecological 54 (2.4%), miscellaneous 31 (1.4%). In 28 cases a conclusive CT examination could not be carried out. The suggested diagnoses were correct in 2,151 cases (96.8%). In 16 cases (0.7%) an incorrect diagnosis was reported, leading to 7 unnecessary laparotomies. False negative reports were obtained in 27 cases (1.2%). After CT examination 500 patients could be discharged immediately. Conclusions Contrast-enhanced CT scanning results in superior diagnostic precision in patients with acute abdominal pain. The present work supports the strategy to include this examination early in the routine diagnostic process.     

Acute Renal Infarction: An Unusual Cause of Abdominal Pain

Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.     

Predicting Acute Urinary Retention in Patients with Elevated Post-Void Residuals

Objectives

To perform a retrospective analysis evaluating factors that may predict which men with elevated post-void residuals (PVRs) that were at increased risk to develop acute urinary retention (AUR).

Methods

We retrospectively analyzed the records of 44 male patients who had 2 consecutive PVRs greater than 100 ml over a 6-month period. Using regression analysis, we evaluated patient''s age, PVR volume, prostate specific antigen (PSA) and transrectal ultrasound prostate volume with respect to development of AUR over 24 months.

Results

Of the 44 patients, 4 developed AUR. When all factors were considered, prostate volume was determined to be the only that was statistically significant (p = 0.003). A 1-SD increase in prostate volume (12 ml) led to a 19.6% increased risk of developing AUR. There was a strong correlation between PSA and prostate volume (0.787). A regression analysis was then repeated excluding prostate volume. PSA then became a statistically significant predictor of AUR (p = 0.007). A 1-SD increase in PSA (1.377 ng/ml) increased the patients'' risk of developing AUR by 12.3%.

Conclusion

In men with an elevated PVR, increased transrectal ultrasound prostate volume or PSA may help predict which patients have an elevated risk of developing AUR within the next 24 months. This information may influence which patients need early surgical intervention versus medical therapy.Key Words: Acute urinary retention, Benign prostatic hyperplasia, Elevated prostate volume, Elevated post void residual, Predicting acute urinary retention     

抚触护理在小儿下腹部术后疼痛干预中的应用

目的 探讨减轻患儿术后疼痛的有效方法.方法 将84例下腹部手术患儿随机分为观察组与对照组各42例,对照组实施常规护理,观察组于术后实施抚触护理,比较两组患儿抚触前后疼痛评分、血压、心率、呼吸变化.结果 观察组疼痛评分显著低于对照组,血压、心率和呼吸显著优于对照组(均P＜0.05).结论 抚触护理有助于缓解患儿下腹部术后的疼痛,维持生命体征稳定.