老年急性胰腺炎的临床特点

笔者对老年急性胰腺炎(AP)患者111例进行分析，现报告如下。     

老年人急性坏死性胰腺炎155例临床特点及治疗体会

回顾性分析本院 2 0年来收治的 155例资料完整的老年急性坏死性胰腺炎 (ＡＮＰ)患者的临床资料 ,报道如下。　　一、资料与方法　　 1981～ 2 0 0 0年 ,共收治ＡＮＰ患者 2 76例 ,年龄 19～ 83岁 ,老年组 ( 60～ 83岁 ) 155例 ( 56 2 % ) ,其中 60～ 69岁 97例(占老年组的 62 6% ) ;非老年组 ( 19～ 59岁 ) 12 1例( 4 3 8% )。所有ＡＮＰ患者均符合全国胰腺会议 (成都市 ,19 96年 )诊断标准〔1〕。依据手术记录、ＣＴ检查统计胰腺坏死面积 :<3 0 %、3 1%～ 50 %、51%～ 10 0 %予以评价。病因、并发症、治疗情况依据病历记录统计。老年组行…     

老年重症急性胰腺炎临床特点

本文回顾性分析了老年人与中青年人重症急性胰腺炎（severe acute pancreatitis，SAP）临床特点，现报告如下。     

老年重症急性胰腺炎患者的临床特点

为了探讨老年重症急性胰腺炎 (ｓｅｖｅｒｅａｃｕｔｅｐａｎｃｒｅａｔｉｔｉｓ ,ＳＡＰ)患者的临床特点和治疗方法 ,我们回顾性分析了 47例老年ＳＡＰ患者的临床资料 ,现报道如下。　　一、资料与方法1 .临床资料 :1993年 1月 1日至 2 0 0 0年 12月 31日收住我院的老年急性胰腺炎患者 15 4例 ,符合ＳＡＰ诊断标准者 47例 ,男 2 2例 ,女 2 5例 ,男∶女为 1∶1 1;年龄 6 0～ 83岁 ,平均 6 7 3岁。其中 6 0～ 6 9岁 30例 ,70～ 79岁 15例 ,82岁和 83岁各 1例。内科综合治疗 18例 ,手术治疗 2 9例。同期非老年组 85例 ,男 41例 ,女 44例 ,男∶…     

老年急性胰腺炎的临床特点及预后分析

目的研究老年急性胰腺炎的临床特点及预后。方法回顾性分析51例老年与53例同期非老年病人（非老年组）的临床资料。结果老年组病人合并糖尿病及高血压者明显高于非老年组，多器官功能衰竭明显多于非老年组。老年组中血CRP水平〉100mg／L，占47．1％，非老年组中血CRP水平〉100mg／L，占20．6％（P〈0．01）。结论老年人急性胰腺炎具有临床表现不典型、病情重、并发症多的特点，积极内科综合治疗，能改善病人预后。     

老年急性胰腺炎的临床特点

随着老龄化社会的到来,急性胰腺炎在老年人群体中的发病率有着逐渐上升的趋势,现阶段及未来都应得到重视。本文通过相关文献综述,阐述了老年急性胰腺炎患者的病因、病理生理特征、临床表现与并发症、诊断方法、治疗和预后,以期为该病的诊断和治疗提供参考。     

老年人急性胰腺炎

老年人急性胰腺炎徐世平王孟薇急性胰腺炎是老年人急腹痛的一个重要原因，约占５％～７％。由于老年人急性胰腺炎具有病情重、合并症多、病死率高等特点，因此充分了解和掌握其特点，进行正确及时的诊断和治疗，对减少并发症、提高患者生存率尤为重要。下面就老年人急性胰...     

老年急性胰腺炎53例临床分析

目的探讨老年急性胰腺炎的临床特征及诊治方法。方法回顾性分析53例老年急性胰腺炎患者的临床资料。结果老年急性胰腺炎多合并有基础疾病,诱发因素主要为胆系疾病39例,占73.6%,临床主要表现为腹痛、腹胀、发热等。行急诊手术9例,术后6例发生并发症,经对症处理后均好转,死亡3例;行择期手术21例,术后发生并发症10例,经对症处理后均好转;其余23例经非手术保守治疗痊愈。结论老年急性胰腺炎主要病因为胆系疾病,临床表现多种多样,症状不典型,且合并症多,病情重,内科积极治疗有助于改善预后。     

老年急性胰腺炎的临床特点及其声像图表现

本文收集了近年来在我院住院的65例老年急性胰腺炎患者的临床及超声声像图资料,并与同期非老年急性胰腺炎的资料进行对比分析,探讨老年急性胰腺炎的临床特点及其声像图表现.     

老年重症急性胰腺炎与慢性胰腺炎的治疗

老年人急性胰腺炎比中青年轻，重症胰腺炎的ＣＴ分级多数为Ｂ级与Ｃ级，很少有Ｄ级与Ｅ级，这可能是老年人的反应性较低下之故。但是老年人有动脉硬化，胰动脉硬化、缺血及胆石症发生率较高，即使脂食摄入量不多也容易诱发急性胰腺炎，甚至慢性胰腺炎。由于老年人多有心血...     

老年急性阑尾炎的临床特征

[目的]探讨老年急性阑尾炎患者的临床特征。[方法]随机选取2011年1月～2013年1月在我院诊治并经最后手术确诊的老年急性阑尾炎患者58例,对其临床特点、治疗效果和术后并发症进行分析。[结果]患者以食欲减少、精神不振（100%）等症状为主要表现,其次为腹胀47例（81.03%）;有21例（36.20%）患者有典型的转移性右下腹痛,体温高于38.5℃者8例（13.79%）;手术治疗的痊愈率98.00%,无死亡患者;患者手术后的并发症共10例,占17.24%,其中切口感染8.62%,肺部感染3.45%,多器官的功能衰竭3.45%,患者的平均住院时间（12±2.36）d。[结论]老年急性阑尾炎常合并有其他基础疾病,病情往往复杂,易延误治疗,诊断成立后,如果无明确的手术禁忌证,建议尽早手术治疗,对提高患者的治愈率,降低患者的并发症及死亡发生率具有显著意义。     

老年急性早幼粒细胞白血病的临床及预后

目的探讨老年急性早幼粒细胞白血病（APL）与年轻APL患者的临床表现、对治疗反应性及长期生存情况,明确老年患者在现有砷剂联合维甲酸及化疗的治疗模式下的有效性和安全性。方法收集北京大学人民医院血液病研究所的247例APL病例,其中老年组21例、年轻组226例,统计临床资料并分析缓解率、复发率、死亡率、存活时间。结果（1）老年APL在性别、白细胞、血红蛋白、血小板、弥散性血管内凝血（DIC）、中枢神经系统白血病（CNSL）及免疫表型上与年轻患者未见明显差异。（2）老年组完全缓解（CR）率、诱导期死亡率稍优于年轻组（100.0%vs 95.1%,0.0%vs 4.4%）,但差异均无统计学意义（P＝0.301,P＝0.325）;复发率及CR期死亡率稍高于年轻组（19.0%vs 16.3%,4.8% vs 1.9%）,差异亦无统计学意义（P＝0.744,P＝0.095）。（3）4年、6年和7年总存活率及无事件存活率与年轻组比较均无显著差异（P＞0.05）。结论老年APL与年轻APL在临床特点、对治疗的反应性及长期生存上无明显差异,现有治疗模式对老年患者安全、有效。     

强化胰岛素治疗在老年重症急性胰腺炎患者中的临床作用

目的探讨强化胰岛素治疗控制血糖对于老年重症急性胰腺炎患者的临床意义。方法将40例〉70岁老年重症急性胰腺炎患者分成强化胰岛素治疗组（I组）和非强化治疗组（N组）,I组通过胰岛素静脉泵将空腹血糖（FBG）控制在4.4～6.1 mmol/L。N组当FBG〉11.1 mmol/L时使用胰岛素治疗并将FBG控制在10.0～11.1 mmol/L。观察2组血糖变化情况、APACHEⅡ评分变化情况、并发症发生情况、住院时间。结果（1）I组在治疗后1 d血糖降至正常水平,且较入院时明显下降,N组在治疗后3 d才较入院时明显下降;（2）I组在治疗后3 d APACHEⅡ评分较入院时明显下降,N组APACHEⅡ评分在治疗后7 d较入院时明显下降（P均〈0.05）;（3）I组住院时间明显短于N组（P〈0.01）;（4）I组与N组总体并发症发生情况无明显差异,但I组手术病人的并发症发生显著低于对照组（P〈0.05）。结论强化胰岛素治疗控制血糖对于改善老年重症急性胰腺炎患者的预后具有积极意义,并可减少手术患者并发症的发生。     

重症急性胰腺炎患者器官功能衰竭的临床特点与治疗

器官功能衰竭是导致重症急性胰腺炎(SAP)患者死亡的重要因素。近年得益于对SAP病理生理研究的进一步深入和经验技术的不断积累,在SAP患者器官功能衰竭诊断治疗方面取得了长足的进步。介绍了SAP并发器官功能衰竭的临床特点和SAP应注意重点加强的治疗措施。目前认为SAP一旦发生容易造成器官功能衰竭,及时规范的治疗能缩短病程,显著降低病死率。     

首发老年抑郁症的临床特点研究

目的 比较首发老年抑郁症和首发中青年抑郁症患者在发病的临床表现和治疗效果等临床特点的差异.方法 选取符合入组标准的首发老年抑郁症患者60例作为研究对象,同时按照性别、文化程度等选取60例首发中青年抑郁症患者作为对照,通过自制调查问卷获取患者的发病诱因及相关资料,两组患者均服用5-羟色胺再摄取抑制剂(SSRIs)抗抑郁剂治疗8周,采用汉密尔顿抑郁量表(HAMD24)和汉密尔顿焦虑量表(HAMA)评定两组患者的临床症状,并在治疗后1,2,4,8周分别再对两组患者进行HAMD评定,通过计算HAMD减分率来评定治疗效果.结果 首发老年抑郁患者最常见的首发症状为躯体症状,而对照组患者则为失眠.首发老年抑郁患者的HAMD总分、焦虑/躯体化得分显著高于对照组,而睡眠障碍、体质量减轻、日夜变化等得分显著低于对照组.HAMA评定首发老年抑郁患者HAMA总分和躯体因子分高于对照组.在为期8周的研究周期内,SSRIs对首发老年抑郁患者的治愈率为51.7%,对对照组的治愈率为91.7%,前者治愈率明显低于后者,其差异有统计学意义(P<0.01).结论 首发老年抑郁患者最常见的首发症状为躯体症状,同时焦虑、疑病、记忆减退、躯体症状等症状的发生率高于中青年抑郁症患者,但晨重晚轻等生物学改变的发生率较中青年抑郁症患者少见,对SSRIs类抗抑郁剂的治疗效果不如中青年抑郁症患者好.     

Clinical and pathological features of acute interstitial pancreatitis in the aged

Histological examination of the pancreas disclosed acute diffuse interstitial pancreatitis in nine cases (0.62%) out of 1457 autopsies performed in 3 yr at two general hospitals in Tokyo. In this series, there were 11 cases of necrotizing or hemorrhagic pancreatitis. In addition to diffuse phlegmonous inflammation, acute interstitial pancreatitis was characterized by rupture of the ducts and ductules associated with profuse intraluminal exudation of polymorphonuclear leukocytes and protein plugs formation. There was scarce parenchymal or fat necrosis. The interstitial type may represent characteristics of acute pancreatitis in the aged. In all nine cases, there were few clinical signs suggestive of acute pancreatitis, except for shock, that developed rapidly. Duration of the disease was rather short. Diagnosis of acute pancreatitis was not made before death. In five patients, acute pancreatitis was terminally superimposed on other serious ailments. But in the other four cases, acute pancreatitis was disclosed as the primary disease at autopsy. Although there was only one case that had a possibility of being secondary to biliary tract infection, ascending bacterial infection and impaired secretion by atrophic parenchyma seemed to be involved in its pathogenesis.     

The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity

The aim of this study was to investigate the overall clinical characteristics of elderly patients with acute pancreatitis. We retrospectively evaluated 227 consecutively enrolled patients who were admitted with acute pancreatitis. The clinical features, the radiological and laboratory data and the clinical outcome were analyzed according to the age groups (≥65 years vs. <65 years). Among the 227 enrolled patients with acute pancreatitis, there were 85 elderly patients and 142 non-elderly. The mean age of the elderly patients was 72.3 ± 5.5 years and that of the non-elderly was 44.7 ± 11.7 (p < 0.001). For the elderly patients, biliary pancreatitis was the most common cause (56.5%), but alcoholic pancreatitis was most common in the non-elderly patients (45.8%). Although the computed tomography (CT) severity index was significantly higher for the non-elderly patients (p < 0.001), the acute physiology and chronic health evaluation (APACHE II) score was significantly higher for the elderly than that for the non-elderly (p < 0.001). However, the duration of the hospital stay (10.3 ± 9.6 days vs. 11.9 ± 10.1 days, p = 0.619) and mortality (3.5% vs. 0.7%, p = 0.148) were not different between the age-groups. In our study, chronological age had no significant influence on the clinical outcome in spite of the different etiologies and severity of acute pancreatitis.     

Analysis of clinical features of acute pancreatitis in Shandong Province, China

AIM: To investigate and obtain a more comprehensive view of the etiology and clinical features of acute pancreatitis in China. METHOD: The study comprised 1471 patients in 10 cites of China who were admitted to hospitals for acute pancreatitis from January 1992 to December 2002. Data for each patient were collected on a standardized form. RESULTS: Of the 1471 patients (854 men, 617 women; mean age 43.3 years; range 13-82 years), 1280 had mild pancreatitis and 191 had the severe form. Cholelithiasis (20.2%), alcohol (17.3%) and diet-induced (12.4%) were the most frequent etiological factors, followed by biliary tract infections (5.6%), hyperlipidemia (2.3%) and other factors (5.1%). However, in about 36.1% of cases, the etiology of acute pancreatitis still remained unexplained. In coastal regions, cholelithiasis was the most frequent factor but alcohol ranked first in interior regions. In males, a small predominance of alcohol over cholelithiasis was seen (27.4%vs 14.3%) and there was a clear predominance of cholelithiasis over alcohol (28.4%vs 3.2%) in females. The differences in the frequency of cholelithiasis and alcohol between coastal regions and interior regions and males and females were statistically significant (P < 0.01). According to their frequency, complications of acute pancreatitis were pancreatic pseudocyst, pancreatic ascites and bacterial peritonitis, pulmonary infections, multiple organ failure, diabetes mellitus type 2 and shock. CONCLUSION: Cholelithiasis, alcohol and diet-induced factors were the main etiological factors seen in China, whereas cholelithiasis alone predominated in females and alcohol ranked first in males. In about 36.1% of cases, the etiology of acute pancreatitis remained unknown. More attention should be paid to studying the etiologies of acute pancreatitis that remain unknown.     

Analysis of the clinical features of recurrent acute pancreatitis in China

Background Since few systematic studies have focused on recurrent acute pancreatitis in China, we sought to investigate its clinical features, including etiological factors and relative frequency. Methods Patients were selected from a total 1471 patients with acute pancreatitis in ten cities of China. All had been admitted to a hospital with an attack of acute pancreatitis between January 1992 and December 2002. Data for each patient was recorded on a standardized form. Results Of the 1471 patients with acute pancreatitis, 157 (10.7%) had recurrent acute pancreatitis. The majority (63%) were male, with a mean age of 41 years (range, 13–82 years). Regarding the etiology, alcohol (20.4%) and cholelithiasis (20.4%) were the most frequent causes, followed by diet (13.4%), hypertriglyceridemia (8.3%), biliary tract infection (5.7%), other (5.1%), and idiopathic factors (26.8%). Alcohol was most frequent in male patients (30.3%), whereas cholelithiasis was most frequent (34.5%) in female patients. The majority of patients (79.6%) presented with their second attack of pancreatitis. Complications of recurrent acute pancreatitis in order of frequency were pancreatic pseudocyst, multiple organ failure, diabetes mellitus type 2, and shock. Conclusions Recurrent acute pancreatitis remains a frequent disease, with cholelithiasis and alcohol being the most usual etiological factors. Alcohol is the primary etiological factor in male patients. In about 26.8% of cases, the etiology remains unknown.     

Clinical outcomes of acute pancreatitis in patients with cirrhosis

BackgroundAP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis.MethodsThe National Inpatient Sample (NIS) database (2003–2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.ResultsOver 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001).ConclusionAP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.