胸腔积液联合血液浓缩对急性胰腺炎严重度评估的临床价值

目的：探讨胸腔积液、血液浓缩和二者的联合应用对急性胰腺炎疾病严重程度的评估价值，并观察胸腔积液与急性胰腺炎病因，并发症及死亡率的关系。方法：对136例急性胰腺炎住院患者作回顾性分析，急性胰腺腺炎及其严重度评估的标准依据患者的临床表现，实验室检查及增强CT检查。记录患者的胸片和红细胞压积检测结果，并分析胸腔积液与急性胰腺炎患者的病因，并发症及预后的相关性。结果：轻型急性胰腺炎（MAP）96例，重症急性胰腺炎（SAP）40例。SAP患者合并胸腔积液者18例（45％），有血液浓缩现象者6例（15％），胸腔积液和血液浓缩同时存在者5例（12．5％）；MAP患者合并胸腔积液者10例（10．4％），血液浓缩者2例（2．1％），无胸腔积液和血液浓缩同时存在者，两者相比有显著性差异（P＜0．01）；此外，胆源性急性胰腺炎合并胸腔积液者11例（14．4％），酒精性急性胰腺炎合并胸腔积液者5例（48．1％），P＜0．05，结论：胸腔积液，血液浓缩均可作为SAP的独立预测指标，但以胸腔积液联合血液浓缩最为准确。胸腔积液与酒精性急性胰腺炎的病因具有明显的相关性，但未发现胰腺局部并发症如胰腺假性囊肿以及患者死亡率与胸腔积液的关系。

Clinical significance of pleural effusion and hemoconcentration in severity evaluation of acute pancreatitis.

Objective To investigate the clinical significance of pleural effusion, hemoconcentration and combination of these two factors in severity evaluation of acute pancreatitis, and to detect the correlation between pleural effusion and the etiology, local complications and mortality of acute pancreatitis. Methods Clinical data of 136 in-patients with acute pancreatitis were analyzed retrospectively. The criteria for diagnosis and severity evaluation of acute pancreatitis were based on patients' clinical manifestations, laboratory findings and enhanced CT examination. The results of chest X-ray and HCT were recorded, and the correlation between pleural effusion and the etiology, local complications and prognosis of acute pancreaitis were analyzed. Results Of the 136 patients investigated, mild acute pancreatitis (MAP) was found in 96 patients, and severe acute pancreatitis (SAP) in 40, of whom 18 patients(45% ) developed pleural effusion, 6 patients(15%) had complicated hemoconcentration, and 5(12. 5%) had both pleural effusion and hemoconcentration. Among the 96 MAP patients, pleural effusion, complicated hemoconcentration or both were found in 10 patients (10.4%), 2 patients (2. 1%) and none, respectively. The difference between the two groups was significant (P < 0. 01). In addition, there was also significant difference between acute biliary pancreatitis with pleural effusion (14.4%) and acute alcoholic pancreatitis with pleural effusion (48.1%). Conclusions Either pleural effusion or hemoconcentration can be used as independent prognostic parameters for severe acute pancreatitis, though the combined use of these two parameters is most reliable. There is marked correlation between pleural effusion and acute alcoholic pancreatitis, but not so between the local complications such as pancreatic pseudocyst, mortality and pleural effusion.