Orvar K, Johlin F C
Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City.
Arch Intern Med. 1994 Aug 8;154(15):1755-61.
Acute pancreatitis has a spectrum from mild disease to severe organ destruction resulting in multiple system organ failure. In this study, we report data from 21,680 discharge summaries during a 10-year period of patients who had undergone transabdominal angiographic procedures in whom the diagnosis of pancreatitis was noted in the discharge coding. We detected 39 patients in whom pancreatitis was coded during the same hospitalization, but only nine patients had no other risk factors for pancreatitis other than the temporal relation with the angiographic procedure. Three of these nine patients died of complications caused by pancreatitis. All of the patients with poor outcomes in this report fulfilled more than three Ranson criteria within 48 hours of the original angiographic procedure. Abdominal imaging with ultrasound or computed tomography was abnormal in all the patients who fulfilled more than three Ranson criteria. The histology from the surgical procedures or the autopsies performed on the three patients who died showed extensive cholesterol embolization primarily to the visceral organs. Extensive pancreatic necrosis was evident in these patients. We conclude that acute pancreatitis after transabdominal angiographic procedures is a rare but a potential fatal event. The prognosis from this event is partially predicted by the Ranson criteria that are evident within the first 48 hours.
急性胰腺炎的病情轻重不一，从轻症到严重的器官破坏，可导致多系统器官功能衰竭。在本研究中，我们报告了10年间21680份出院小结的数据，这些患者接受了经腹血管造影检查，且出院编码中记录了胰腺炎的诊断。我们发现有39例患者在同一住院期间被编码为胰腺炎，但只有9例患者除了与血管造影检查存在时间关联外，没有其他胰腺炎的危险因素。这9例患者中有3例死于胰腺炎引起的并发症。本报告中所有预后不良的患者在最初血管造影检查后的48小时内均满足超过三项兰森标准。所有满足超过三项兰森标准的患者，其超声或计算机断层扫描的腹部成像均异常。对3例死亡患者进行的外科手术或尸检组织学检查显示，主要在内脏器官出现广泛的胆固醇栓塞。这些患者中可见广泛的胰腺坏死。我们得出结论，经腹血管造影检查后发生的急性胰腺炎是一种罕见但可能致命的事件。该事件的预后部分可通过最初48小时内明显的兰森标准来预测。
