妊娠合并急性胰腺炎的危险因素及临床诊治分析

目的：探讨妊娠合并急性胰腺炎（acute pancreatitis，AP）的危险因素及临床诊治情况。方法回顾性分析40例确诊AP产妇（AP组）和50名健康产妇（对照组）临床资料，经多因素logistic回归分析妊娠期合并AP的危险因素。对比2组受试者血钙、空腹血糖（fasting plasma glucose，FPG）、血脂总胆固醇（total cholesterol，TC）、三酰甘油（triglyceride， TG）]、纤维蛋白原（fibrinogen，FIB）、C反应蛋白（C-reactive protein，CRP）、血清淀粉酶（serum amylase，AMS）、白细胞计数（white blood cells count，WBC）等生化指标检测结果，记录40例AP产妇治疗结局。结果AP组合并胆道疾病、高脂血症、高钙血症、高糖血症比例分别为47.5%、40.0%、42.5%、37.5%，均显著高于对照组（P＜0.05）。经多因素logistic回归分析可知，合并胆道疾病、高脂血症、高钙血症、高糖血症等是影响妊娠合并AP的独立危险因素（P＜0.05）。AP组产妇血钙、FPG、TC、TG、FIB、CRP、AMS、WBC等生化指标检测结果均显著高于对照组（P＜0.05）。40例接受临床治疗的AP产妇均母婴存活，其中27例继续妊娠至足月分娩（10例保守治疗后痊愈，顺产分娩新生儿，母婴平安；17例治疗期间顺产分娩，母婴结局良好），另4例行腹腔置管引流术，术后保守治疗痊愈，6例保守治疗36 h内行剖宫产分娩，3例行剖宫产后接受腹膜后胰腺坏死组织清除术。结论妊娠期合并胆道疾病、高脂血症、高钙血症、高糖血症等可能增加AP发生风险，需引起临床重视；妊娠期AP产妇多存在血脂、血糖、血钙指标异常情况，早期诊断及治疗是获得理想预后的关键。

Risk factors and clinical diagnosis and treatment of acute pancreatitis during pregnancy

Objective To investigate the risk factors and clinical diagnosis and treatment of acute pancreatitis (AP)during pregnancy. Methods The clinical data of 40 patients diagnosed with AP (AP group) and 50 healthy women (control group)were analyzed retrospectively. The risk factors of AP during pregnancy were analyzed by multivariate Logistic regression analysis. The detection results of blood calcium, fasting plasma glucose (FPG), lipids total cholesterol (TC), t r iglycer ide (TG)], f ibr inogen (FIB), C-reactive protei n (CR P), ser u m amylase (A MS), white blood cells cou nt ( W BC)and other biochemical i ndexes were compared between the two groups. The treatment outcomes of 40 cases of puer perae with AP were recorded. Results The percentage of complications with biliary tract disease, hyperlipemia, hypercalcemia and hyperglycemia in AP group (47.5%, 40.0%, 42.5%, 37.5%)was significantly higher than that in the control group (P<0.05). Multivariate Logistic regression analysis showed that complications with biliary tract disease, hyperlipemia, hypercalcemia and hyperglycemia were independent risk factors influencing AP during pregnancy (P<0.05). The levels of blood calcium, FPG, TC, TG, FIB, CRP, AMS, WBC and other biochemical indexes in AP group were significantly higher than those in the control group (P<0.05). All the 40 cases of puerperae with AP who had received clinical treatment and their infants survived. 27 of these cases were still in the pregnant state till full-term delivery. 4 cases underwent abdominal drainage and conservative treatment after operation and were cured. 6 cases received cesarean delivery in 36h during conservative treatment. 3 cases underwent aspiration for retroperitoneal pancreatic necrosis after cesarean section. Conclusion Pregnancy complicated with biliary tract disease, hyperlipemia, hypercalcemia and hyperglycemia may increase the risk of AP, which deserves attention; Most puerperae with AP during pregnancy have abnormal blood lipid, blood glucose and blood calcium. Early diagnosis and treatment are the key to achieving ideal outcomes.