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(P<0.05);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(P<0.05);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(P<0.05)。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。
OBJECTIVE To compare the abdominal infections and prognosis of patients with severe acute pancreatitis （SAP） with different operation time, and compare the changes of perioperative serum inflammatory indexes and serum amylase, so as to provide a reference for the selection of operation time in patients with SAP in clinic.METHODS A total of 108 cases of SAP patients admitted to the hospital from Feb.2014 to Aug.2016 were selected, and were divided into early surgery group （n=34）, middle surgery group （n=36） and late surgery group （n=38） according to the operation time.The clinical indexes and complications of the three groups were compared.RESULTS The APACHE score of early surgery group was higher than that of mid surgery group and late surgery group.The serum levels of CRP, PCT and AMS at 2d, 6d and 1 month after operation in the 3 groups were significantly lower than those before operation.The decrease of CRP and AMS in early surgery group was significantly lower than that in middle surgery group and late surgery group at 2d and 6d after operation （P〈0.05）.The postoperative complication rate of early surgery group was significantly higher than that of mid surgery group and late surgery group, and the mid surgery group was higher than that of the late surgery group （P〈0.05）.The hospitalization time and reoperation rate of early surgery group were significantly higher than those of middle surgery group and late surgery group, and late surgery group were higher than those of mid surgery group.The mortality of middle operation group was significantly lower than that of early surgery group and late surgery group, and late surgery group was lower than that of early surgery group （P＆lt;0.05）.CONCLUSION SAP patients have with complex disease, and change rapidly.The patients with different operation time according to different stages of disease,and doing surgical treatment during systemic infection period under the condition of good infection control can achieve a better prognosis.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第16期3711-3714,共4页
Chinese Journal of Nosocomiology
关键词
重症急性胰腺炎
手术时机
腹腔感染
血清指标
Severe acute pancreatitis
Timing of operation
Abdominal infection
Serum indexes
