重症急性胰腺炎急性期腹腔内置管引流临床观察

目的 观察早期腹腔内留置导管引流治疗重症急性胰腺炎的临床效果.方法 重症急性胰腺炎患者30例,随机分为常规组(16例)和引流组(14例).记录两组患者第0、 3、7、10天急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)和器官衰竭评分(Marshall评分)、腹内压、腹腔引流量、胃肠减压量、呼吸机应用情况,测定相应时间点CD_(14)HLA-DR水平和AT-Ⅲ活性.结果 两组患者入选时各指标比较差异均无统计学意义,第3天起APACHEⅡ评分、Marshall评分、腹内压、胃肠减压量及第7天CD_(14)HLA-DR水平和AT-Ⅲ活性比较差异均有统计学意义(P<0.05).引流组呼吸机应用时间明显低于常规组(P<0.05),28 d生存率明显改善(P<0.05).结论 急性重症胰腺炎患者早期腹腔内置管引流胰腺炎相关性腹水,可明显改善患者病情,提高生存率.

Effect of early drainage of ascitic fluids on severe acute pancreatitis

Objective To investigate the clinical effect of early drainage of ascitic fluids on severeacute pancreatitis(SAP) patients. Methods 30 SAP patients were randomized to receive either standard treatments (standard group) or early drainage of ascitic fluids (drainage group). For all the patients, the scores of APACHEⅡand Marshall were recorded at the 0,3,7 and 10 day. At the same time, the intra-abdominal pressure (IAP), the the amount abdominal cavity drainage, the bowel sound, the volume of gastrointestinal decompression, and the days of ventilator used were recorded, and the levels of CD_(14)HLA-DR and AT-Ⅲ activity were measured. Results There was no difference in each factor between the two groups at the beginning. From the 3th day on, there were significant differences between the two groups in the score of APACHEⅡ, the score of Marshall, the IAP, and the volume of gastrointestinal decompression(P<0.05). To the 7th day the level of CD_(14)HLA-DR and AT-Ⅲ activity were significant difference between two group.The time of ventilator used in drainage group was obviously shorter than in standard group.The survival rate for 28 days in drainage group was obviously improved (P<0.05). Conclusion The pancreatitis-associated ascitic fluids play an important role in the progression of SAP. Early drainage of ascitic fluids can obviously improve the condition of SAP, and increase the survival rate.