重症急性胰腺炎36例临床诊治分析

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1、重症急性胰腺炎36例临床诊治分析冠县人民医院摘要：目的分析重症急性胰腺炎(SAP)的病

2、大I、临床表现、辅助检查及诊治要点，以提高对该病认识。方法回顾性分析冠县人民医院消化内科2010年6月〜2011年5月收治的36例SAP患者临床资料，对病因、临床表现、实验室结果、影像学表现及治疗情况汇总分析。结果36例患者胆源性26例，高血脂症性5例，酗酒2例，ERCP后2例，妊娠1例；患者多以腹痛为首发症状(8&9%),腹痛、低血压与休克者(11.1%),消化道出血者(13.9%),心肌酶升高者(5.6%),空腹血糖(FPG)升高者15例⑷.7%)

3、,Grey-Tuener征者(5.6%)；淀粉酶呈>3XULN升高(96.2%),淀粉酶不升高或小于3XULNC3.8%)；CT表现为肾周围区消失、网膜囊和网膜脂肪变性、密度增厚、胸腔积液、腹水等改变；液体复苏、生长抑素、抑酸、胰酶抑制剂、应用抗生索、屮药治疗、外科手术及并发症处理与对症支持治疗后除3例死亡外其余均痊愈出院。结论SAP多以腹痛、高热、黄疸、休克、胸腹水、消化道出血等为主耍临床表现；常有胆道疾患、酗酒、高脂血症等病史或有暴饮暴食、脂餐等诱因；血淀粉酶可有明显升高或升高不明显甚至正常，早期行腹部CT检查有助于明清诊断；早期施以

4、积极、有效、综合的非手术治疗疗效明确。关键词：重症急性胰腺炎；病因；影像学；血•淀粉酶；综合治疗Severeacutepancreatitis:aclinicalanalysisof36casesShengBai-longTianRui-longZhaoYuan-yuanWuFeng-yanGuanxianpeople'sHospitalDepartmentofInternalMedicineAbstract：ObjectiveAnalysisofsevereacutepancreatitis(SAP)intheetiology,clin

5、icalmanifestation,auxiliaryexaminationanddiagnosisandtreatment,toimprovetheknowledgeaboutthedisease..Methods.RetrospectiveanalysisofShangdongProvince-ownedHospitalfromJuneto2011May2010digestionDepartmentofinternalmedicinetreated36casesofSAPpatientsclinicaldataontheetiolog

6、y,clinicalmanifestations,laboratoryfindings,imagingfindings,andtreatmentofmeta-analysis.ResuIts;In36casesofpatientswithgallstonein26cases,5casesofhyperlipemia,alcoholismin2cases,ERCP2cases,1casesofpregnancy;patientswithabdominalpainasinitialsymptom(88.9%),abdominalpain,hy

7、potensionandshock(11.1%),gastrointestinalbleeding(13.9%),myocardialenzymeincreased(5.6%),fastingbloodsugar(FPG)increasedin15cases(41.7%),Grey-Tuenersyndrome(5.6%);amylasewas>3xULN(96.2%)elevatedamylaseisnotelevated,orlessthan3xULN(3.8%);CTshowedperirenalareadisappeared,th

8、eomentalbursaandomentaladiposedegeneration,density,pleuralthickeninge什usion,abdominalwaterchange;fluidresuscitation,somatostatin,acidsuppression,trypsininhibitors,antibiotics,Chinesemedicinetreatment,surgicaloperationandcomplicationsaftertreatmentandsymptomatictreatment,e

9、xcept3casesofdeathoftheremainingwerecured.ClusionSAPwithabdominalpain,highfever,jaundice,shock,h