重症急性胰腺炎临床表现及疗效价值的分析

目的探讨重症急性胰腺炎的临床特征及治疗方案的选择与预后的关系。方法2003年1月至2007年12月共收治重症急性胰腺炎患者783例,治疗方案根据中华医学会外科学分会胰腺外科学组制定的《重症急性胰腺炎诊治原则草案》进行选择。其中胆源性胰腺炎375例,手术治疗182例,非手术治疗193例。非胆源性胰腺炎408例,手术治疗147例,非手术治疗261例。结果共治愈患者698例,治愈率89.1%。胆源性胰腺炎患者治愈357例,治愈率95.0%,其中手术治疗治愈17l例,治愈率94.0%,非手术治疗治愈。186例,治愈率96.4%;非胆源性胰腺炎患者治愈341例,治愈率84.0%,其中手术治疗治愈110例,治愈率74.8%,非手术治疗治愈231例,治愈率88.5%。存活患者中有84%发生了脏器功能障碍,其中18.3%为多脏器功能障碍综合征(MODS)。而死亡患者中100%有脏器功能障碍,其中97.6%为MODS。呼吸功能障碍、神经系统障碍与休克的发生率最高,分别为26.3%、11.7%和10.3%,死亡患者中呼吸、肾和心功能障碍的发生率最高分别为94.1%、60.0%和60.0%。存活与死亡患者真菌感染的发生率分别为8.9%与37.6%;消化道瘘发生率分别为0.9%和14.1%。结论针对胆源性胰腺炎的病因治疗和针对胰腺坏死感染的手术治疗是提高疗效的关键因素;MODS是造成胰腺炎患者死亡的主要原因,其中呼吸、肾和心功能障碍危险性较高。

The characteristic of severe acute pancreatitis and the selection of the therapeutic strategy

0bjective To investigate the relationship between the clinical character and theraDeutic strategy and prognosis in severe acute pancreatitis.Methods From January 2001 to December 2005 783 patients with SAP were treated.Therapeutic strategy was selected based on the preliminary scheme for diagnosis and treatment ot severe acute pancreatitis by pancreatic surgery society of CMA.All the patients were divided into biliary group and nonbiliary group,while 375 patients in biliary group,with 1 82 patients treated operatively and 193 patients treated nonoperatively;and 408 patients in nonbiliary group,with 147 patients treated operatively and 261 patients treated nonoperatively.Results There were 698 survivals.The overall survival rate was 89. 1%.357 survivals in the biliary SAP group,the survival rate was 95.0%.in which 171 survivals from operation treated cases,with the survival rate of 94.0%.and 186 survivals from nonoperatmn treated cases,with the survival rate of 96.4%;34l surviv- als in the nonbiliary SAP group.The survival rate was 84.0%,in which 110 survivals from operation treated cases.with the survivaJ rate 0f 74.8%,and 231 survivals from nonoperation treated cases.with the survival rate of 88.5%,48.3% patients of the survival group had organ dysfunction,and 18.3% patients had multiple organ dysfunctions. while 100% patients of the death group had organ dysfunction,and 97.6% patients had multiPle organ dysfunction.Respiratory dysfunction was found to be the most common cause totalbr foltowed bv nerve svstem dysfunction and shock,with the rates of 26.3%, 11.7%and 10.3%,respectively, Respirator, dysfunction,renaJ dysfunction and cardiac dysfunction are most commonly in death group,with the rate of 94.1%,60.0% and 60.0%, respectively,The rate of fungi infection in the survival group and death groupwere8. 9%and 37.6%,The ratesre of alimentary tract fistula in the survial and death group were0.9% and 14.1%,respevtively.Conclusion The therapy aiming at the cause for biliary SAP and theoperation aiming at infeceted pancreatic necrosis is helpful to improvecurative rate ;MODS is the main cause of death in severe acute pancreatitis. Respiratory dysfunction are high risk factors.