妊娠期合并急性胰腺炎60例分析

发布时间：2018-04-28 03:07

本文选题：妊娠期 + 急性胰腺炎　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:探讨年龄、孕次、孕期、病因、体重指数等对妊娠期合并急性胰腺炎严重程度的影响,及妊娠期合并急性胰腺炎对实验室检查指标和妊娠预后的影响。方法:回顾性分析四川省人民医院2006年1月至2015年12月收治的60例妊娠期合并急性胰腺炎患者的临床资料。根据急性胰腺炎诊断指南(2014年)标准严重程度分级,分为轻症、中重症、重症三组。并对年龄、孕次、孕期、发病原因(胆源性、高脂血症性、其它)、体重指数、实验室检查指标(血清淀粉酶、尿淀粉酶、血清脂肪酶、超敏C反应蛋白、血糖、血钙、甘油三酯、谷草转氨酶、谷丙转氨酶、白蛋白、总胆红素、直接胆红素、碱性磷酸酶)、妊娠预后等资料进行统计和分析。结果:1.一般情况比较:统计所有病例,患者发病年龄区间为17-40岁,其中初产妇19例(31.67%),经产妇41例(68.33%);孕期分类:妊娠早期5例(8.33%),妊娠中期3例(5.00%),妊娠晚期52例(86.67%);疾病严重程度分类:轻症34例(56.67%),中重症14例(23.33%),重症12例(20.00%);病因分类:胆源性35.00%(21/60)包含胆囊结石23.33%(14/60)、胆囊炎8.33%(5/60)、胆总管结石1.67%(1/60)、胆管炎1.67%(1/60),高脂血症占33.33%(20/60),其它31.67%(19/60)包括饮食因素的10例(16.67%)、甲状旁腺功能亢进的3例(5.00%)和不明原因的6例(10.00%)。2.妊娠期合并急性胰腺炎的严重程度情况:(1)年龄、孕次、孕期对疾病严重程度影响:不同年龄、怀孕次数、孕期对疾病严重程度比较无显著差异(P0.05)。(2)病因对妊娠期合并急性胰腺炎的严重程度影响:不同病因引起的疾病严重程度差异有统计学意义(P0.05);再经组间两两比较,检验水准校正为α=0.017,胆源性病因组与高脂血症病因组比较有显著差异(P0.017);但胆源性病因组、高脂血症病因组分别与其它病因组比较,发生不同严重程度疾病的情况无显著差异(P0.017)。(3)体重指数对妊娠期合并急性胰腺炎严重程度影响:在正常、超重、I度肥胖组比较,三个不同严重程度组比较无显著差异(P0.05);在Ⅱ度肥胖组中,三个不同严重程度组比较有显著差异(p0.05);据体重指数等级相关分析显示,随着体重指数等级的增加,疾病严重程度也增加,呈现出正相关的关系(r=0.269)。(4)妊娠期合并急性胰腺炎对实验室指标的比较:(1)一般血清生化指标:三组不同严重程度的妊娠合并急性胰腺炎在血清淀粉酶、尿淀粉酶、血清脂肪酶中比较无差异(p0.05);而三组患者在超敏c反应蛋白、血糖、血钙、甘油三酯水平均有显著差异(p0.05),经两两比较显示,各组间均存在差异(p0.05);具体表现为,随着妊娠合并急性胰腺炎严重程度的增加,超敏c反应蛋白、血糖、甘油三酯均不断增加,血钙不断降低。(2)肝功能指标:不同严重程度的妊娠期合并急性胰腺炎的谷草转氨酶、谷丙转氨酶、白蛋白指标均存在统计学差异(p0.05),随着病情严重程度的增加,谷草转氨酶、谷丙转氨酶水平不断增高,白蛋白水平不断降低;虽然数据显示随着疾病病情加重,总胆红素、直接胆红素水平也呈现增高趋势,但经两两比较分析显示,总胆红素、直接胆红素水平仅在轻度组和重度组间存在差异(p0.05)。3.妊娠期合并急性胰腺炎对妊娠预后的影响:本研究中,无孕产妇死亡,围产期儿有6例死亡。终止妊娠有25例(41.67%),2例妊娠早期患者人为选择流产(3.33%);1例妊娠中期患者人为选择引产(1.67%);22例选择剖宫产(36.67%),其中11例胎儿达到足月而行剖宫产,另外11例因治疗期间胎儿宫内发生窘迫征象行急诊剖宫产。三个不同严重程度组在剖腹产、早产率方面比较无显著意义(p0.05);轻症组在足月顺产率高于中重症组、重症组,差异有统计学意义(p0.05);不同严重程度的妊娠期合并急性胰腺炎,在死胎引产率、胎儿宫内窘迫发生率、新生儿窒息发生率、死亡率方面比较有显著差异(p0.05)。在合并重症急性胰腺炎的孕妇中,胎儿宫内窘迫、死胎、新生儿窒息乃至死亡风险均明显增高。外科干预有11例,其中6例急性胰腺炎病情不重,术中未扰动胰腺仅行腹腔引流;5例sap患者行胰周坏死组织清除和胰周引流术,其中还有2例合并胆囊结石加行胆囊切除术和胆道探查术。结论:1.胆源性和高脂血症是妊娠期合并急性胰腺炎的主要病因,胆源性妊娠期急性胰腺炎以轻症为主,而高脂血症更易导致中重症甚至重症急性胰腺炎。2.随着体重指数等级的增加,妊娠期合并急性胰腺炎的严重程度也有加重的趋势。3.随着妊娠期合并急性胰腺炎病情分级加重,肝功能损害程度也有增加的趋势。4.妊娠期合并重症急性胰腺炎患者的胎儿宫内窘迫、死胎、新生儿窒息乃至死亡的风险均明显增高。5.在轻症、中重症妊娠期合并急性胰腺炎患者中,采用积极非手术治疗,多能够得到有效控制,预后情况较好;在重症妊娠期合并急性胰腺炎患者中,除积极非手术治疗外,若出现产科和外科干预指针时需要考虑手术治疗,治疗方式尽可能选择剖宫产,同时结合病情选用外科术式。
[Abstract]:Objective: To investigate the influence of age, pregnancy, pregnancy, etiological factor, body mass index on the severity of acute pancreatitis in pregnancy, and the effects of acute pancreatitis on laboratory examination and pregnancy prognosis. Methods: a retrospective analysis of 60 cases of pregnancy combined with acute pregnancy from January 2006 to December 2015. Clinical data of patients with pancreatitis. According to the standard severity grade of the acute pancreatitis diagnostic guide (2014), it is divided into light, medium, severe, three groups. The age, pregnancy, pregnancy, cause of disease (biliary, hyperlipidemia, other), body mass index, laboratory examination index (serum amylase, urine amylase, serum lipase, hypersensitivity C) The data of protein, blood sugar, blood calcium, triglyceride, glutamic aminotransferase, glutamic pyruvidase, albumin, total bilirubin, direct bilirubin, alkaline phosphatase, and pregnancy prognosis were statistically analyzed. Results: 1. general cases were compared: all cases were 17-40 years of age, of which 19 cases (31.67%) were primipara and 41 cases (68.3 3%): pregnancy classification: 5 cases in the early pregnancy (8.33%), 3 cases in the middle of pregnancy (5%), 52 cases of late pregnancy (86.67%); the classification of disease severity: 34 cases (56.67%), 14 cases (23.33%), serious 12 cases (20%); etiology classification: choledocholithiasis (21/60), cholecystitis (5/60), choledocholithiasis (1/60), gallbladder. 1.67% (1/60), hyperlipidemia, 33.33% (20/60), other 31.67% (19/60) including 10 cases of dietary factors (16.67%), 3 cases of hyperparathyroidism (5%) and 6 cases of unexplained (10%).2. pregnancy with acute pancreatitis: (1) age, pregnancy, and pregnancy severity of the disease: different age, pregnancy times There was no significant difference in the severity of the disease during pregnancy (P0.05). (2) the effect of the cause on the severity of acute pancreatitis in pregnancy: the difference in the severity of the disease caused by different causes was statistically significant (P0.05); the test level was a =0.017, and the group of biliary venereal diseases was compared with the cause of hyperlipidemia. There were significant differences (P0.017), but there was no significant difference between the cause of hyperlipidemia and other etiological groups (P0.017). (3) the influence of body mass index on the severity of acute pancreatitis in pregnancy: in the normal, overweight, and I obesity group, three different severity groups were compared There was no significant difference (P0.05); in the obese group, there were significant differences in three different severity groups (P0.05). According to BMI correlation analysis, the severity of disease increased with the increase of BMI (r= 0.269). (4) the ratio of acute pancreatitis to laboratory indexes during pregnancy. (1) general serum biochemical indexes: there was no difference in serum amylase, urine amylase and serum lipase (P0.05) in three groups of different severity of pregnancy combined with acute pancreatitis (P0.05), while in the three groups, there were significant differences in the level of hypersensitive C reaction protein, blood sugar, blood calcium and triglyceride (P0.05). The difference between each group showed that there was a difference between each group. Difference (P0.05); specifically, with the increase of acute pancreatitis in pregnancy, hypersensitivity C reactive protein, blood glucose, triglyceride were all increasing, and blood calcium decreased continuously. (2) liver function index: gluten aminotransferase, alanine aminotransferase and albumin index in different severity of pregnancy with acute pancreatitis P0.05, with the increase of the severity of the disease, the level of glutamic aminotransferase and alanine transaminase increased and the level of albumin decreased. Although the data showed that the level of total bilirubin and direct bilirubin increased with the disease aggravation, but the total bilirubin and direct bilirubin level were only mild after 22 comparison. The difference between the group and the severe group (P0.05).3. pregnancy combined with acute pancreatitis on the pregnancy prognosis: in this study, there were no maternal deaths and 6 perinatal deaths. There were 25 cases of termination of pregnancy (41.67%), 2 cases of early pregnancy induced abortion (3.33%); 1 cases of mid-term pregnancy induced abortion (1.67%); and 22 cases of cesarean section. 36.67%), 11 of them reached full term for cesarean section, the other 11 cases of fetal distress in the treatment of the fetus during the treatment of the emergency cesarean section. Three different severity groups in the caesarean section, the rate of premature delivery was not significant (P0.05); in the light disease group was higher than the middle of severe group, severe group, the difference was statistically significant (P0.05) There were significant differences in the incidence of fetal distress, fetal distress, neonatal asphyxia, and mortality (P0.05). In pregnant women with severe acute pancreatitis, the risk of fetal distress, stillbirth, neonatal asphyxia and even death was significantly higher in pregnant women with severe acute pancreatitis. There were 11 cases, of which 6 cases of acute pancreatitis were not serious, without abdominal drainage in the operation, 5 cases of SAP patients underwent peripancreatic necrotic tissue clearance and peripancreatic drainage, of which 2 cases combined cholecystectomy with cholecystectomy and biliary tract exploration. Conclusion: 1. cholelithiasis and hyperlipidemia are the main diseases associated with acute pancreatitis in pregnancy. Acute pancreatitis in GD is mainly light, while hyperlipidemia is more likely to cause severe or severe acute pancreatitis.2. with the increase of body mass index. The severity of acute pancreatitis in pregnancy also has a tendency to aggravate the severity of.3. with the severity of acute pancreatitis in pregnancy and the degree of liver dysfunction. There is also an increase in the risk of fetal distress, stillbirth, asphyxia and even death of the patients with severe acute pancreatitis in.4. pregnancy. The risk of.5. in the patients with severe acute pancreatitis is significantly higher in patients with severe pregnancy and acute pancreatitis, with active non operative treatment, more effective control, better prognosis, and severe pregnancy. In patients with acute pancreatitis, in addition to active nonsurgical treatment, surgical treatment should be considered if the indications of obstetric and surgical intervention appear. The treatment of caesarean section should be chosen as far as possible, and the surgical procedure is selected in combination with the condition of the disease.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.255

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