Tao Hou-Quan, Zhang Jing-Xia, Zou Shou-Chun
Department of Surgery, Zhejiang Provincial Peoples' Hospital, Hangzhou 310014, Zhejiang Province, China.
World J Gastroenterol. 2004 Mar 15;10(6):919-21. doi: 10.3748/wjg.v10.i6.919.
To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP).
Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixty-nine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAP. The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared.
Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31+/-0.68 vs 3.68+/-0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs 7.5%, P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE II score, Balthazar CT class, MODS and hypoxemia.
ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.
研究早期重症急性胰腺炎（ESAP）患者的临床特征及治疗方法。
回顾1991年1月至2003年6月期间我院收治的297例症状发作后72小时内入院的重症急性胰腺炎（SAP）患者的数据，以分析早期重症急性胰腺炎（ESAP）的发生及发展情况。ESAP定义为症状发作后72小时内出现器官功能障碍。69例患者为ESAP，228例症状发作后72小时内无器官功能障碍的患者为SAP。比较ESAP和SAP的临床特征、住院期间器官功能障碍的发生率及预后。
ESAP患者胰腺损伤程度（Balthazar CT分级）比SAP患者更严重（5.31±0.68 vs 3.68±0.29，P<0.01）。ESAP的死亡率高于SAP（43.4% vs 2.6%，P<0.01），低氧血症发生率更高（85.5% vs 25%，P<0.01），胰腺感染发生率更高（15.9% vs 7.5%，P<0.05），腹腔间隔室综合征（ACS）发生率更高（78.3% vs 23.2%，P<0.01），多器官功能障碍综合征（MODS）发生率更高（78.3% vs 10.1%，P<0.01）。多因素logistic回归分析显示，ESAP的主要诱发因素为较高的APACHE II评分、Balthazar CT分级、MODS和低氧血症。
ESAP的特点是MODS、胰腺严重病理改变、早期低氧血症和腹腔间隔室综合征。鉴于ESAP预后较差，这些患者应在专科重症监护病房接受治疗，并采取密切监测、液体复苏、改善低氧血症、减少胰腺分泌量、清除炎症介质、预防和治疗胰腺感染等特殊措施。
