手术时机对重症急性胰腺炎患者腹腔感染与相关血清指标的影响研究

发布时间：2018-04-16 06:52

本文选题：重症急性胰腺炎 + 手术时机　；参考：《中华医院感染学杂志》2017年16期

【摘要】：目的比较不同手术时机重症急性胰腺炎(SAP)患者腹腔感染及预后情况,并比较围术期血清炎症指标和血清淀粉酶的变化,为临床SAP患者手术时机的选择提供参考。方法选择2014年2月-2016年8月医院收治的108例SAP患者,按照手术时机分组,34例患者为早期手术组,36例患者为中期手术组,38例患者为晚期手术组,比较3组患者临床指标及并发症情况。结果早期手术组急性生理与慢性健康评分(APACHEⅡ评分)高于中期、晚期手术组,术后2d、6d、1个月3组患者血清CRP、PCT、AMS均较术前显著下降,术后2d、6d,早期手术组CRP、AMS下降幅度显著低于中期、晚期手术组(P0.05);早期手术组患者术后并发症率显著高于中期、晚期手术组,中期手术组高于晚期手术组(P0.05);早期手术组住院时间、再手术率均显著高于中期、晚期手术组,晚期手术组上述指标高于中期手术组,中期手术组患者死亡率显著低于早期手术组和晚期手术组,晚期手术组低于早期手术组(P0.05)。结论 SAP患者病情复杂,变化较快,综合不同病程分期实施手术的预后情况,在患者感染控制良好的情况下,选择全身感染期行手术治疗,能取得较好的预后。
[Abstract]:Objective to compare the celiac infection and prognosis in patients with severe acute pancreatitis (SAP) at different operative times, and to compare the changes of serum inflammatory indexes and serum amylase in perioperative period so as to provide reference for the choice of surgical timing in patients with SAP.Methods one hundred and eight patients with SAP were selected from Feb 2014 to Aug 2016. According to the time of operation, 34 patients were divided into early operation group (36 patients) and intermediate operation group (38 patients).The clinical indexes and complications of the three groups were compared.Results the acute physiological and chronic health scores of the early operation group were higher than those of the middle stage group. In the late operation group, the serum levels of CRPnPCTMS were significantly lower in the late operation group than in the middle stage at 2 days after operation and 1 month in the 3 groups, and at 2 days after operation and 6 days after operation, the extent of decrease in the early operation group was significantly lower than that in the middle operation group.The rate of postoperative complications in the early operation group was significantly higher than that in the middle stage group, the late operation group was higher than that in the late operation group, and the reoperation rate in the early operation group was significantly higher than that in the middle and late operation group, and the postoperative complication rate in the early operation group was significantly higher than that in the late operation group.The mortality of the patients in the middle operation group was significantly lower than that in the early operation group and the late operation group, and the mortality rate in the late operation group was lower than that in the early operation group (P 0.05).Conclusion the patients with SAP are complicated and change rapidly. Under the condition of good infection control, the patients can get a better prognosis by choosing the stage of systemic infection.
【作者单位】：安阳市人民医院普外科;安阳县中医院外二科;
【分类号】：R657.51

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