Deleplanque P, Alcalay D, Rouffineau J, Pourrat O, Carretier M, Descoins P, Barbier J
Centre Régional de Transfusion Sanguine, Poitiers.
Ann Med Interne (Paris). 1988;139 Suppl 1:86-7.
A 27 year-old alcoholic patient with severe acute pancreatitis (4 Ranson's objective prognostic signs), complained of abdominal pain and vomiting and presented fever and rigors. The plasma was of milky turbidity and the concentration of triglycerides (TG) very high (26 Mmol/l, Normal: 3-1.6). Serum pancreatic amylase was elevated (262 U/l, Normal: 10-200). The electrocardiogram (ECG) showed S-T depression. The diagnosis was confirmed by computed tomography which showed a pancreatic phlegmon and a collection in the left pararenal space (Ranson's grade D). After PE on days 1 and 2: the amylase became normal, plasma clear, TG decreased (7.8 Mmol/l), the clinical picture improved and the ECG normal. Assisted ventilation was necessary over 10 days. Pancreatic morphology remained unchanged. The patient was discharged to intensive care on day 18. There was no indication for surgery. The fast drop in TG levels, the precursors of free fatty acids, may have limited their toxicity the pancreas, allowing a difficult stage to be over come and the course of the illness to interrupted. Normalization of the ECG requires emphasis. The association of HG, increased plasma amylase and abdominal pain justifies early iterative PE.
一名27岁患有严重急性胰腺炎（具备4项兰森客观预后指标）的酗酒患者，主诉腹痛和呕吐，伴有发热和寒战。血浆呈乳状浑浊，甘油三酯（TG）浓度极高（26毫摩尔/升，正常范围：3 - 1.6）。血清胰淀粉酶升高（262 U/升，正常范围：10 - 200）。心电图（ECG）显示ST段压低。计算机断层扫描确诊为胰腺蜂窝织炎，左肾旁间隙有积液（兰森分级D级）。在第1天和第2天进行血浆置换（PE）后：淀粉酶恢复正常，血浆变清，TG下降（7.8毫摩尔/升），临床症状改善，心电图恢复正常。辅助通气持续了10天。胰腺形态保持不变。患者于第18天转入重症监护病房。无手术指征。游离脂肪酸前体TG水平的快速下降，可能限制了它们对胰腺的毒性，使病情度过了艰难阶段并中断了病程。心电图恢复正常值得强调。高甘油三酯血症、血浆淀粉酶升高和腹痛同时出现，说明早期反复进行血浆置换是合理的。
