急性重症胰腺炎的致死性并发症分析

目的 了解急性重症胰腺炎（Severe acute pancreatitis,SAP)的器官功能衰竭或局部并发症与病死率的关系。方法 通过对19年我院收治的112例SAP回顾调查，了解SAP并发症如休克、ARDS、胰性脑病和全身感染发生率与SAP病死的关系。结果 SAP112例患者，治愈92例（82.1%），死亡20例，病死率为17.8％，发生各种并发症73例（65.2%）。肺功能不全、休克、胰性脑病和全身感染与病死率有关，分别占病死率的6.3%、7.8%、5.3%和3.5%。SAP器官或代谢合并症综合评分大于7分组和评分小于7分组，两组病死率有非常显著差异（P＜0.01）。20例SAP患者死亡并发症为休克（7例）、ARDS（6例）、全身感染（3例）、出血（2例）和胰性脑病（2例）。结论 SAP病人死亡原因不是SAP本身，而是其并发症，SAP综合评分在7分以上者，其SAP器官或代谢合并症较多；在各种并发症中休克、肺功能不全、胰性脑病、出血和全身感染才是死亡最主要的原因。

Analysis on lethal complications of severe acute pancreatitis

Objective To study the relationship of the organic function failure or the local complications with the mortality of the patients with severe acute panrceatitis (SAP). Methods A total of 112 patients with the severe acute panrceatitis admitted and treated in our hospital in past 19 years were retrospectively study for the incidence rates of complications such as shock, acute respiratory distress syndrome (ARDS), pancreatic brain diseases and whole body infections, and for the relation between these complications and the mortality. Results Among 112 patients with SAP, 92 patients were cured with the rate of 82.1%, and 20 patients were died with the mortality as 17.8%. About 62.5% of them suffered the complications related mortality, such as ARDS, shock, pancreatic brain disease and the whole body infection with the incident rates of 6.3%, 7.8%, 5.3% and 3.5% respectively. The patients were divided into above 7 score group and below 7-score group by the composite scores based on the organic functional or diabetic complications. The 2 groups had very significant difference on the mortality ( P <0.01). Conclusion The death of the patients with SAP is not only due to SAP itself, but also its complications, especially the organic or diabetic complications. Among them, shock, ARDS, pancreatic brain diseases, bleeding and the whole body infection are the significant reasons to blame.