妊娠合并急性胰腺炎的临床特点分析

发布时间：2018-03-07 14:22

本文选题：妊娠期合并急性胰腺炎　切入点：病因　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的急性胰腺炎(Acute pancreatitis,AP)是较常见的一种急腹症,但是发生在妊娠期的AP在临床中不多见,妊娠期合并AP的病因较多,不仅包括胆道疾病、高脂血症及暴饮暴食等常见因素,还有一些少见因素如药物、手术等,也可导致AP。妊娠期合并AP起病急、发展快、死亡率高,如果治疗不及时,可引起母体低血容量、感染性休克、水电解质酸碱平衡紊乱、多器官功能障碍综合征(multiple organs dysfunction syndrome,MODS),甚至导致死亡。对于母体来说,可能会出现流产、早产等不良后果,对胎儿的影响是可能出现宫内窘迫、宫内死胎等结局。本研究回顾性分析妊娠期急性胰腺炎的临床特征,以期增强对妊娠期合并急性胰腺炎的认识,有助于及早确诊并及时治疗,改善妊娠期急性胰腺炎的预后。资料和方法回顾性分析郑州大学第一附属医院2008年2月至2016年4月收治的587例急性胰腺炎(Acute pancreatitis,AP)患者的临床资料,其中65例妊娠期急性胰腺炎患者纳入研究组,522例非妊娠期急性胰腺炎女性患者为对照组,对比分析妊娠期合并急性胰腺炎(Acute pancreatitis in pregnancy,APIP)发病的病因、临床特点、并发症及误诊原因。结果1.病因分析:引起妊娠期急性胰腺炎的相关因素中,研究组的主要病因有:1)胆石症和胆道疾病占44.6%(29/65),2)高脂血症为24.6%(16/65),3)暴饮暴食及饮酒为18.5%(12/65),4)其他因素(如甲状旁腺功能亢进、感染、药物、手术等)占12.5%(8/65);对照组常见的主要病因为:1)胆道系统疾病占53.4%(279/522),2)高脂血症为21.3%(111/522),3)暴饮暴食和饮酒为16.3%(85/522),4)其他因素占9.0%(47/522)。实验室检查中:研究组血脂水平明显高于对照组。研究结果表明,在引起AP的病因分析中,研究组和对照组中胆道系统疾病和高脂血症、暴饮暴食之间差异均无统计学意义(P0.05);研究组和对照组中血脂水平差异有统计学意义(P0.05)。2.临床特点:研究组中轻症急性胰腺炎所占的比例为63.1%(41/65),中重症急性胰腺炎的比例为36.9%(24/65);对照组中发生轻症AP的比例是78.4%(409/522),中重症AP占21.6%(113/522)。妊娠期合并急性胰腺炎患者中,发生重症急性胰腺炎的比例明显高于非妊娠期发生重型急性胰腺炎的比例。(P0.05)。3.误诊率:研究组起病时误诊的病例数为39例,误诊率达60.0%,其中误诊为早产28例,胎盘早剥2例,急性胃肠炎3例,急性阑尾炎4例,急性胆囊炎2例;对照组的误诊率为19.3%(101/522),分别被误诊为急性阑尾炎18例、急性胃肠炎30例,急性胆囊炎19例,肠梗阻34例。妊娠期急性胰腺炎的误诊率明显高于普通患者AP(P0.05)。4.妊娠期合并急性胰腺炎对母亲及胎儿的影响(治疗结局):研究组有2例因胆囊结石行胆囊切除术,5例因胆管结石行经内镜逆行胰胆管造影术(Endoscopic Retrograde Cholangiopancreatography,ERCP),3例行血浆置换,2例患者死亡(死亡率3.1%);对照组中522例患者中365例经保守治疗后好转,57例因胆囊结石行胆囊切除术,92例因胆管结石行ERCP术,有8例因严重并发症死亡(死亡率1.5%)。对母体生育方面,研究组31例(47.7%)行剖宫产,11例(16.9%)自然分娩,7例先兆早产(10.8%),6例(9.2%)流产,8例继续妊娠。对胎儿影响方面,7例胎儿死亡(5例宫内死胎,2例出生后因重度窒息死亡),死亡率为10.8%;出生的婴儿健康存活。结论1.妊娠期合并急性胰腺炎和非妊娠期急性胰腺炎的病因均主要为胆源性疾病和高脂血症,而且APIP的甘油三脂水平明显高于普通AP。因此,对于以前有高脂血症以及有胆道系统疾病的患者,应定期做好产前诊断和检查,更要注意合理饮食,并对相关疾病及早诊治,以便早期预防,从而降低妊娠期急性胰腺炎的发病率。2.由于妊娠期急性胰腺炎患者的临床表现不典型,且部分医师对妊娠期合并AP的认识不足,更容易导致漏诊、误诊,提高误诊率。因此,临床上要高度警惕妊娠期合并AP的患者,依据病人的临床表现、实验室检查以及影像学检查,早期诊断,进一步做到早期治疗,以降低该病的漏诊、误诊率;必要时积极请相关科室会诊以协助诊治,减少不良结局的发生。3.妊娠合并AP多见于妊娠中晚期,若疾病不及时控制,可严重威胁母婴安全,且患者个体差异较大,因此APIP治疗上在强调“个体化治疗”的同时[1],还要按不同病因及病程分期应用不同的治疗方案。
[Abstract]:Objective to acute pancreatitis (Acute pancreatitis AP) is a kind of common acute abdomen during pregnancy, but the occurrence of AP in clinical rare, the etiology of pregnancy complicated with AP, including not only the common factors of biliary tract disease, hyperlipidemia and overeating, there are some rare factors such as drugs, surgery etc. AP., can also lead to pregnancy AP acute onset, rapid development, the mortality rate is high, if not timely treatment, can cause maternal hypovolemia, septic shock, water electrolyte and acid-base balance disorders, multiple organ dysfunction syndrome (MODS multiple organs dysfunction syndrome), and even lead to death. For mother, may miscarriage, premature birth and other adverse consequences, the effects on the fetus is possible fetal distress, fetal death and other outcomes. This study retrospectively analyzed the clinical features of acute pancreatitis during pregnancy, in order to enhance pregnancy together Understanding and acute pancreatitis, contribute to the early diagnosis and timely treatment, improve the prognosis of acute pancreatitis during pregnancy. Materials and methods of analysis of 587 cases of acute pancreatitis in the First Affiliated Hospital of Zhengzhou University from February 2008 to April 2016 were reviewed (Acute, pancreatitis, AP) in patients with clinical data, including 65 cases of acute pancreatitis during pregnancy were included in the study group, 522 cases of female non pregnant patients with acute pancreatitis as control group, comparative analysis of pregnancy complicated with acute pancreatitis (Acute pancreatitis in pregnancy, APIP) the clinical characteristics, etiology, complications and causes of misdiagnosis. Results: 1. etiological analysis of related factors of acute pancreatitis during pregnancy cause, main causes of study group are: 1) cholelithiasis and biliary disease accounted for 44.6% (29/65), 2) hyperlipidemia was 24.6% (16/65), 3) binge eating and drinking for 18.5% (12/65), 4) and other factors (such as thyroid Drug parathyroid hyperfunction, infection, surgery, etc.) accounted for 12.5% (8/65); the control group of common disease mainly because: 1) biliary diseases accounted for 53.4% (279/522), 2) hyperlipidemia was 21.3% (111/522), 3) overeating and drinking was 16.3% (85/522), other 4) factors accounted for 9% (47/522). Laboratory examination: a study of lipid levels was significantly higher than the control group. The results of the study show that, in the cause analysis of AP in the study of biliary diseases and hyperlipidemia group and control group, overeating were no significant differences between (P0.05); the difference was statistically significant study on the serum lipid level group and the control group (P0.05.2.): a study of clinical features of mild acute pancreatitis group in the proportion of 63.1% (41/65), in the proportion of severe acute pancreatitis was 36.9% (24/65); mild AP occurred in the control group were 78.4% (409/522), severe AP accounted for 21.6% (113/522) during pregnancy. In patients with acute pancreatitis, severe acute pancreatitis was higher than that of non occurrence of severe acute pancreatitis during pregnancy. The ratio of (P0.05).3. misdiagnosis rate: the study group was misdiagnosed cases for 39 cases, the misdiagnosis rate was 60%, among which the misdiagnosis of 28 cases of premature delivery, 2 cases of placental abruption, 3 cases of acute gastroenteritis, 4 cases of acute appendicitis, 2 cases of acute cholecystitis; control group, the misdiagnosis rate was 19.3% (101/522), 18 cases were misdiagnosed as acute appendicitis, 30 cases of acute gastroenteritis, 19 cases of acute cholecystitis, 34 cases of intestinal obstruction. The misdiagnosis of acute pancreatitis during pregnancy was significantly higher than that of ordinary patients with AP (P0.05) effect on maternal and fetal.4. in pregnancy complicated with acute pancreatitis (outcome): study group 2 cases of cholecystectomy, 5 cases with biliary calculi underwent endoscopic retrograde cholangiopancreatography (Endoscopic Retrograde, Cholangiopancreatography, ERCP, 3) Routine plasmapheresis, 2 patients died (mortality 3.1%); the control group in 522 cases, 365 cases were cured by conservative treatment, 57 cases of cholecystectomy, 92 cases with biliary calculi underwent ERCP, 8 cases died of severe complications (mortality 1.5%). On the maternal family. The study group of 31 cases (47.7%) underwent cesarean section, 11 cases (16.9%) of natural childbirth, 7 cases of threatened premature labor (10.8%), 6 cases (9.2%) of 8 cases of abortion, pregnancy continued. Effects on the fetus, fetal death in 7 cases (5 cases of intrauterine fetal death, 2 cases of severe asphyxia after birth death). The mortality rate was 10.8%; a baby born healthy survival. Conclusion the causes of pregnancy complicated with acute pancreatitis and 1. non pregnant women with acute pancreatitis were mainly biliary diseases and hyperlipidemia, and APIP glycerin three fat levels were significantly higher than that of ordinary AP. therefore have hyperlipidemia and patients with biliary tract disease in previously should Do regular prenatal diagnosis and examination, should pay more attention to the reasonable diet, and the diseases related to early prevention, early diagnosis and treatment, so as to reduce the incidence of acute pancreatitis during pregnancy rate of.2. due to the clinical manifestations of patients with acute pancreatitis during pregnancy is not typical, and some doctors understanding of pregnancy complicated with AP, more easily lead to misdiagnosis. To improve the rate of misdiagnosis, misdiagnosis. Therefore, patients should be alert to pregnancy in patients with AP, according to the clinical manifestations, laboratory examination and imaging examination, early diagnosis, early treatment and further, to reduce the misdiagnosis, the misdiagnosis rate; if necessary please actively consultations to assist in diagnosis and treatment, reduce the the incidence of adverse outcomes of pregnancy.3. AP in pregnancy, if the disease can not control, a serious threat to the safety of mother and child, and with individual differences, because of this APIP treatment on" [1], at the same time as individualized therapy, also applies different treatments according to the different etiological and course stages.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.255

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