高原低氧时急性胰腺炎患者多器官功能变化及意义

目的 探讨高原低氧环境下急性胰腺炎(AP)发生发展的特点及与高原红细胞增多症(高红症)的关系.方法 选择本院2003年至2005年收治的103例AP患者,其中有12例合并高红症(高红症AP组);根据海拔高度分为高海拔组(>3 000 m,57例)、中低海拔组(<2 200 m,46例).收集患者入院时的临床指标,并进行急性生理学与慢性健康状况评分系统I(APACHE I)评分,分析各组肝、肾、肺功能的变化.结果 高红症AP组患者丙氨酸转氨酶(ALT)、肌酐(Cr)均明显高于非高红症AP组(ALT:(160.70±19.14)U/L比(78.00±14.96)U/L,Cr:(135.45±11.99)μmol/L比(91.42±17.08)μmol/L,均P<0.05],动脉血氧分压(PaO_2)、动脉血氧饱和度(SaO_2)明显低于非高红症AP组PaO_2:(45.10±0.40)mm Hg比(65.48±1.36)mm Hg,1 mm Hg=0.133 kPa,SaO_2:0.851±0.004比0.940±0.009,均P<0.05];而两组间天冬氨酸转氨酶(AST)、尿素氮(BUN)和动脉血二氧化碳分压(PaCO_2)水平比较差异无统计学意义AST:(87.35±8.10)U/L比(83.00±18.61)U/L,BUN:(10.90±0.97)mmol/L比(7.37±0.98)mmol/L,PaCO_2:(33.20±0.31)mm Hg比(25.32±1.14)mm Hg,均P>0.05].高海拔组ALT和Cr明显高于中低海拔组ALT:(126.92±15.46)U/L比(86.00±10.23)U/L,Cr:(126.10±10.01)μmol/L比(101.84±5.46)μmol/L,均P<0.05];AST、BUN、PaCO_2略高于中低海拔组(AST:(98.70±8.10)U/L比(93.14±21.46)U/L,BUN:(8.15±1.00)mmol/L比(5.86±0.40)mmol/L,PaCO_2:(32.32±1.01)mm Hg比(30.12±2.76)mm Hg],PaO_2、SaO_2略低于中低海拔组CPaO_2:(58.80±1.20)mm Hg比(66.86±3.20)mm Hg,SaO_2:0.910±0.011比0.930±0.008],但差异无统计学意义(均P>0.05).结论 高原环境下AP患者肝、肾、肺功能损害与高红症及海拔高度有关.

The changes and significance of multiple organ functions in acute pancreatitis patients under hypoxic condition on plateau

Objective To explore characteristics of the pathogenesis and progression of the acute pancreatitis CAP) in high altitude and the relationship between AP and plateau erythrocythemia. Methods Retrospective analysis of the clinical data of AP was conducted for 103 inpatients who were admitted during 2003 and 2005 to the People's Hospital of Qinghai Province, including 12 cases of AP complicated with plateau erythrocythemia and 91 cases of AP no complicating plateau erythrocythemia. The patients were divided into a group of 57 cases living in high altitude (>3 000 m) and 46 patients in lower altitude group (<2 200 m). Clinical data of the patients were collected at admission, and liver, kidney and lung functions were determined for all patients. Results Alanine aminotransferase (ALT) and creatinine (Cr) were significantly higher in AP complicating plateau erythrocythemia compared with AP patients without complicating plateau ery-throcythemia ALT: (160.70±19.14) U/L vs. (78.00±14.96) U/L, Cr: (135.45±11.99) μmol/L vs. (91.42±17.08) μmol/L, both P<0.05]. Arterial partial pressure of oxygen (PaO-2) and arterial oxygen saturation (SaO_2) were significantly lower in AP with complication of plateau erythrocythemia than in AP without complicating plateau erythrocythemia PaO_2: (45.10±0.40) mm Hg vs. (65.48±1.36) mm Hg, 1 mm Hg=0.133 kPa, SaO_2: 0.851±0.004 vs. 0.940±0.009, both P<0.05]. There was no difference in aspartate aminotransferase (AST), blood urea nitrogen (BUN) and arterial partial pressure of carbon dioxide (PaCO_2), however, their levels were higher in plateau erythrocythemia cases than those without plateau erythrocythemia AST: (87.35±8.10) U/L vs. (83.00±18.61] U/L, BUN: (10.90±0.97) mmol/L vs. (7.37±0.98) mmol/L, PaCO_2: (33.20±0.31) mm Hg vs. (25.32± 1.14) mm Hg, all P>0.05]. ALT and Cr were significantly higher in high altitude cases than those in lower altitude cases ALT: (126.92±15.46) U/L vs. (86.00±10.23) U/L, Cr: (126.10±10.01) μmol/L vs. (101.84±5.46) μmol/L, both P<0.05]. There was no difference in AST, BUN and PaCO_2, however, the values were slightly higher in high altitude cases compared with lower altitude cases CAST: (98.70± 8.10) U/L vs. (93.14±21.46) U/L, BUN: (8.15±1.00) mmol/L vs. (5.86±0.40) mmol/L, PaCO_2: (32.32±1.01) mm Hg vs. (30.12±2.76) mm Hg, all P>0.05]. There was no difference in PaO_2 and SaO_2, however, it was slightly lower in high altitude cases than lower altitude cases PaO_2: (58.80± 1.20) mmHg vs. (66.86±3.20) mm Hg, SaO_2: 0.910±0.011 vs. 0.930±0.008, both P>0.05]. Conclusion The results showed that the deterioration of hepatic, kidney and lung function in AP patients living in the plateau was related to high altitude and erythrocythemia.