摘要
目的 观察行胰腺功能系统检查的危重死亡患儿临床与病理特征,分析脓毒性休克、脓毒症,乳酸水平与胰腺损害的关系.方法 分析湖南省儿童医院2009年1月至2012年10月行胰腺功能系统观察,并因病情危重抢救死亡后行全身和胰腺病理检查的64例危重患儿临床及病理资料,观察所有病例的胰腺组织学特征,并进行病理学分级评分.结果 （1）脓毒性休克患者胰腺组织病理学评分、入院24h血脂肪酶最高值较非脓毒性休克患者显著升高,而住院期间Ca2＋最低值显著降低（P＜0.05）；（2）乳酸升高≥2倍组较乳酸升高＜2倍组及乳酸正常组胰腺组织病理学评分显著升高（P＜0.05）,但住院期间Ca2＋最低值、入院24h血淀粉酶、脂肪酶、尿淀粉酶含量乳酸升高≥2倍组与乳酸升高＜2倍组及乳酸正常组比较差异无统计学意义；（3）胰腺组织病理学评分＞4分组入院24h血淀粉酶、脂肪酶、尿淀粉酶含量较胰腺组织病理学评分≤4分组显著增高（P＜0.05）,但胰腺组织病理学评分＞3分组与胰腺组织病理学评分≤3分组比较差异无统计学意义.结论 （1）脓毒性休克患者,尤其是脓毒性休克合并高乳酸血症患者更容易造成胰腺功能损害；（2）胰腺组织病理学评分＞4分能作为判断胰腺损害的有效指标.
Objective To study the exocrine pancreatic function in critically ill children with septic shock,sepsis and hyperlactacidemia.Methods A total of 64 critical pediatric patients were admitted from Jan 2009 to Oct 2012,and clinical and laboratory findings including pancreatic function,and histopathological features and score after autopsy were reviewed.Results （1） Compared with non-septic shock children,the pancreatic pathology score and serum lipase in septic shock group were significantly higher and serum calcium was significantly reduced （P ＜0.05） ; （2） The pancreatic histopathology score was significantly increased in patients with elevated plasma lactate ≥2 times （P ＜0.05）,but there were no significant differences in serum calcium and blood amylase and lipase between patients with elevated plasma lactate level and patients with normal plasma lactate level; （3） The concentrations of serum amylase,lipase and urinary amylase were significantly increased in patients with pancreatic histopathology score ＞4 points compared with score ≤4 points patients,but there were no significant differences in above three biomarkers between patients with score ≤3 points and patients with score ＞3 points.Conclusions The pancreas is vulnerable to damage easily occurred in septic shock children especially complicated with hyperlactacidemia.The pancreatic histopathology score ＞ 4 points can be as a sensitive and reliable indicator of pancreas damage.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2014年第2期157-162,共6页
Chinese Journal of Emergency Medicine
基金
国家＂十二五＂重大科技支撑项目（2012BAI04B00）
