老年重症急性胰腺炎早期治疗中超声引导下经皮穿刺置管灌洗引流对临床疗效及实验室指标的影响

发布时间：2018-03-04 01:37

本文选题：超声引导　切入点：胰腺炎　出处：《中国老年学杂志》2017年14期 　论文类型：期刊论文

【摘要】：目的研究老年重症急性胰腺炎早期治疗中超声引导下经皮穿刺置管灌洗引流对临床疗效及实验室指标的影响。方法选取46例老年重症急性胰腺炎患者,按随机数字表法将其分为对照组(n=22)和研究组(n=24)。其中对照组患者采用常规保守治疗,而研究组患者采用超声引导下经皮穿刺置管灌洗引流治疗。对比两组两组患者心率、体温、症状、体征(发热、呕吐、腹胀、腹痛、肌紧张、反跳痛、腹部压痛及发热)消失时间、总住院天数及恢复饮食天数。统计胰腺假性囊肿、胰周脓肿、代谢紊乱、早期多脏器功能障碍综合征(MODS)、休克、急性心力衰竭、胰性脑病、急性肾功能衰竭、急性呼吸窘迫综合征等并发症的发生情况。动态观察治疗前后腹部超声检查改变。观察两组患者治疗前、治疗后(48~72 h)的尿淀粉酶、血淀粉酶、血钙、血糖、血白细胞计数等。结果 29例研究组患者均成功完成治疗,引流管放置4~8根,治疗时间45~96 min,术后无严重并发症如胃肠道损伤、大出血等发生,术后患者腹部症状明显减轻或有所减轻。其中成功置管23例,经引流管引流出浑浊或血性腹腔积液,因坏死组织黏稠,引流不畅,引流管阻塞后加压冲洗侧口管无效者6例,进行重新置管后腹腔积液均成功引出。术后灌洗引流时间6~23 d。研究组患者的心率、体温、症状体征消失时间、总住院天数、血淀粉酶恢复正常天数和恢复饮食天数均明显低于对照组差异具有统计学意义(P0.05),对照组22例患者中保守治疗后痊愈出院10例,7例好转,3例进行积极非手术治疗后病情持续恶化,中转手术后好转,2例患者出现严重并发症,其中1例患者死于胰性脑病,1例患者死于MODS。研究组24例患者中引流效果好,痊愈出院18例,5例好转,无中转手术,1例患者出现严重并发症MODS,抢救无效死亡。对照组患者治疗有效率为77.3%,研究组患者治疗有效率为95.8%,两组患者治疗有效率对比差异具有统计学意义(χ2=5.668,P0.05)。治疗后两组患者的胰腺体积均有不同程度的缩小。两组患者治疗前尿淀粉酶、血淀粉酶、血钙、血糖和血白细胞计数等指标差异无统计学意义(P0.05)。治疗后,两组患者各项指标均出现显著差异(P0.05),研究组患者血钙水平明显高于治疗前(t=4.630,P0.05),尿淀粉酶、血淀粉酶、血糖、血白细胞计数等指标均明显低于治疗前(t=5.241,8.601,5.918,6.020,P均0.05)。结论 SAP早期治疗中采用超声引导下经皮穿刺置管灌洗引流治疗可有效避免开放性外科手术的创伤及出现的并发症,具有有效、安全的特点,在早期积极进行SAP非手术综合治疗过程中应密切关注并发症的发生和有无胰腺感染,对有手术指征的患者应及时进行手术治疗,避免延误病情。
[Abstract]:Objective to study the effect of ultrasonic guided percutaneous catheter lavage and drainage on clinical efficacy and laboratory indexes in the early treatment of severe acute pancreatitis in the elderly. Methods 46 elderly patients with severe acute pancreatitis were selected. The patients in the control group were treated with conventional conservative therapy, while the patients in the study group were treated with percutaneous catheter lavage and drainage under the guidance of ultrasound. The heart rate and body temperature of the two groups were compared. Symptoms, signs (fever, vomiting, abdominal distension, abdominal pain, muscle tension, rebound pain, abdominal tenderness and fever) disappeared, total days of hospitalization and days of recovery of diet. Statistics of pancreatic pseudocyst, peripancreatic abscess, metabolic disorder, Early multiple organ dysfunction syndrome mods, shock, acute heart failure, pancreatic encephalopathy, acute renal failure, Dynamic observation of the changes of abdominal ultrasound before and after treatment. The urine amylase, serum amylase, serum calcium, blood glucose were observed before and after treatment in both groups. Results all the 29 patients in the study group were successfully treated with 48 drainage tubes for 4596 minutes. There were no serious postoperative complications such as gastrointestinal injury, massive hemorrhage, and so on. The abdominal symptoms of the patients were relieved or alleviated, of which 23 cases were successfully placed, and 6 cases were treated with turbid or bloody celiac effusion drainage due to necrotic tissue viscosity, obstruction of drainage tube, failure of pressure flushing side orifice tube. The postoperative lavage and drainage time was 6 ~ 23 days. The heart rate, body temperature, symptoms and signs disappeared, and the total hospitalization days, the heart rate, body temperature, symptoms and signs of the patients in the study group were disappeared. The days of serum amylase recovery and diet recovery were significantly lower than those of the control group (P 0.05). In the control group, 10 cases recovered after conservative treatment, 7 cases recovered and 3 cases continued to deteriorate after active non-operative treatment. There were serious complications in 2 patients who had improved after the transfer operation, 1 case died of pancreatic encephalopathy and 1 case died of MODS.The study group had good drainage effect among 24 cases, 18 cases recovered and 5 cases improved. The effective rate of treatment in the control group was 77.3 and the effective rate of the study group was 95.8.The difference between the two groups was statistically significant (蠂 2 5.668 P 0.05). After treatment, the pancreatic volume in both groups was reduced to varying degrees. There was no significant difference in serum amylase, calcium, blood glucose and white blood cell count between the two groups. After treatment, there were significant differences in all the indexes between the two groups. The serum calcium level of the patients in the study group was significantly higher than that of the patients in the study group before and after treatment, and the levels of serum amylase, amylase and amylase in urine were significantly higher than those in the study group. Blood glucose and white blood cell count were significantly lower than those before treatment. Conclusion Ultrasound-guided percutaneous catheter lavage and drainage can effectively avoid trauma and complications in open surgery. It is effective and safe. We should pay close attention to the occurrence of complications and pancreatic infection in the early non-operative comprehensive treatment of SAP. The patients with surgical indications should be treated in time to avoid delay.
【作者单位】：浙江大学附属第一医院超声医学科;
【基金】：杭州市卫生局课题(No.2013A13)
【分类号】：R445.1;R576

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