妊娠期不同分级急性胰腺炎患者的临床特点及预后分析

发布时间：2019-01-10 19:14

【摘要】：目的探讨妊娠期不同分级急性胰腺炎(AP)患者的临床特点及预后。方法选取2005年1月—2014年12月厦门大学附属福州第二医院收治的妊娠期AP患者38例,根据2012年亚特兰大AP标准和2013年版《中国急性胰腺炎诊治指南》AP分级诊断标准分为轻度AP(MAP)组17例、中度AP(MSAP)组13例和重度AP(SAP)组8例,对比3组患者的年龄、发病时间、发病原因、误诊率、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、局部并发症、器官功能衰竭和母儿病死率情况。结果 3组患者年龄、发病时间、发病原因、误诊率比较,差异均无统计学意义(P0.05)。MAP组、MSAP组、SAP组患者APACHEⅡ评分分别为(6.3±2.0)分、(9.0±2.6)分、(12.1±3.2)分,其中MSAP组和SAP组患者APACHEⅡ评分高于MAP组,SAP组患者APACHEⅡ评分高于MSAP组(P0.05)。MAP组患者无局部并发症;MSAP组发生急性胰周液体积聚10例、胰腺假性囊肿2例、急性坏死物积聚1例;SAP组发生急性坏死物积聚4例、急性胰周液体积聚2例、胰腺假性囊肿1例、包裹性坏死1例。MAP组患者未发生器官功能衰竭,MSAP组患者发生器官功能衰竭4例(30.8%),SAP组患者发生器官功能衰竭8例(100.0%)。MAP组、MSAP组和SAP组终止妊娠例数分别为5例、3例和7例,均采用剖宫产方式。MAP组和MSAP组均未发生孕产妇和胎儿死亡。SAP组出现1例孕产妇死亡,死因为多器官功能衰竭伴严重腹腔感染;3例胎儿死亡,其中1例为母儿死亡,1例为入院时胎儿已死亡,另1例剖宫产终止妊娠后死亡。结论妊娠期AP多发生于妊娠中晚期,病因以胆囊结石和高三酰甘油血症为主,临床容易误诊。妊娠期MAP无局部并发症和器官功能衰竭,预后好。妊娠期MSAP所伴局部并发症以急性胰周液体积聚为主,或可出现一过性器官功能衰竭,但以单器官功能衰竭为主,经积极治疗处理后,预后较好。妊娠期SAP以急性坏死物积聚局部并发症和持续性多器官功能衰竭为主,母儿病死率较高,是救治的重点和难点。
[Abstract]:Objective to investigate the clinical features and prognosis of (AP) patients with different grades of acute pancreatitis during pregnancy. Methods from January 2005 to December 2014, 38 AP patients with pregnancy were treated in Fuzhou second Hospital affiliated to Xiamen University. According to the Atlanta 2012 AP criteria and the 2013 Chinese guidelines for the diagnosis and treatment of Acute pancreatitis, they were divided into mild AP (MAP) group (n = 17), moderate AP (MSAP) group (n = 13) and severe AP (SAP) group (n = 8). Time, cause, misdiagnosis rate, acute physiological function and chronic health status scoring system 鈪，

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