Browder W, Patterson M D, Thompson J L, Walters D N
Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City.
Ann Surg. 1993 May;217(5):469-74; discussion 474-5. doi: 10.1097/00000658-199305010-00006.
The incidence of acute pancreatitis in the elderly patient is increasing, and a significant number of such patients have no clearly defined etiology of their pancreatitis. To delineate the role of early organ failure versus progressive pancreatic disease in the morbidity and mortality, the authors' experience with patients older than 60 years with acute pancreatitis was reviewed.
As many as 30%-40% of elderly patients with acute pancreatitis have an unclear etiology and such patients have high rates of early organ failure and death. While some authorities have shown that pre-existing disease in these elderly patients did not contribute to subsequent morbidity, others have demonstrated that poor outcome was related to co-existing medical illness.
Their review of acute pancreatitis in the elderly was grouped into known and unknown etiology patients. Various parameters such as morbidity, mortality and length of stay were then compared between the two groups. Severity of organ failure and acute pancreatitis on admission were both graded and attempts made to correlate this severity with subsequent outcome.
Unknown etiology patients had a greater number of Ranson's criteria (3.5 +/- .44 vs. 2.4 +/- .18) (p < 0.02), higher morbidity (48% vs. 22%) (p < 0.05), higher mortality (24% vs. 8.3%), and more SICU days (4.4 +/- 1.3 vs. 1.6 +/- .44) (p < 0.05) when compared with the known etiology group. Duration of symptoms, admission hypotension, and Ranson's criteria were unsuccessful in predicting mortality. Functional status of the various organ systems on admission did predict subsequent mortality.
Elderly patients with acute pancreatitis of unknown etiology present with a more severe disease, have higher morbidity and longer SICU stays, and appear to have greater compromise of organ function. Organ function compromise correlates with mortality and appears more significant than severity of pancreatic disease. Aggressive support of such organ systems may be beneficial in the management of these patients.
老年患者急性胰腺炎的发病率正在上升，且相当一部分此类患者的胰腺炎病因尚不明确。为了阐明早期器官衰竭与进行性胰腺疾病在发病率和死亡率中的作用，作者回顾了60岁以上急性胰腺炎患者的情况。
多达30%-40%的老年急性胰腺炎患者病因不明，此类患者早期器官衰竭和死亡率很高。虽然一些权威人士表明这些老年患者先前存在的疾病与随后的发病率无关，但其他人则证明不良结局与并存的内科疾病有关。
他们将对老年急性胰腺炎的回顾分为病因已知和未知的患者。然后比较两组之间的各种参数，如发病率、死亡率和住院时间。对入院时器官衰竭和急性胰腺炎的严重程度进行分级，并试图将这种严重程度与随后的结局相关联。
与病因已知组相比，病因不明的患者有更多的兰森标准（3.5±0.44对2.4±0.18）（p<0.02），更高的发病率（48%对22%）（p<0.05），更高的死亡率（24%对8.3%），以及更多的外科重症监护病房（SICU）住院天数（4.4±1.3对1.6±0.44）（p<0.05）。症状持续时间、入院时低血压和兰森标准未能成功预测死亡率。入院时各器官系统的功能状态确实可预测随后的死亡率。
病因不明的老年急性胰腺炎患者病情更严重，发病率更高，SICU住院时间更长，且器官功能似乎受损更严重。器官功能受损与死亡率相关，且似乎比胰腺疾病的严重程度更显著。积极支持此类器官系统可能有利于这些患者的治疗。
