重症急性胰腺炎36例临床诊治分析.docVIP

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)的病因、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(88.9%)，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(41.7%)，Grey-Tuener征者(5.6%)；淀粉酶呈3×ULN升高(96.2%)，淀粉酶不升高或小于3×ULN(3.8%)；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、应用抗生素、中药治疗、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、消化道出血等为主要临床表现；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 Severe acute pancreatitis: a clinical analysis of 36 cases Sheng Bai-long Tian Rui-long Zhao Yuan-yuan Wu Feng-yan Guanxian peoples Hospital Department of Internal Medicine Abstract：Objective Analysis of severe acute pancreatitis (SAP) in the etiology, clinical manifestation, auxiliary examination and diagnosis and treatment, to improve the knowledge about the disease..Methods. Retrospective analysis of Shangdong Province-owned Hospital from June to 2011 May 2010 digestion Department of internal medicine treated 36 cases of SAP patients clinical data on the etiology, clinical manifestations, laboratory findings, imaging findings, and treatment of meta-analysis.Results; In 36 cases of patients with gallstone in 26 cases, 5 cases of hyperlipemia, alcoholism in 2 cases, ERCP 2 cases, 1 cases of pregnancy; patients with abdominal pain as initial symptom (88.9%), abdominal pain, hypotension and shock (11.1%), gastrointestinal bleeding (13.9%), myocardial enzyme increased (5.6%), fasting blood sugar (FPG) increased in 15 cases (41.7%), Grey-Tuener syndrome (5.6%); amylase was 3 × ULN (96.2%) elevated amylase is not elevated, or less than 3 × ULN (3.8%); CT showed perirenal area disappeared, the omental bursa and omental adipose degeneration, density, pleural thickening effusion, abdominal water change; fluid resuscitation, somatostatin, acid