摘要
目的探讨腹腔穿刺引流（APD）时机对伴有大量腹腔积液的重症急性胰腺炎（SAP）患者病程转归的影响。方法以2012年1月至2017年1月成都军区总医院收住的107例SAP患者为研究对象，根据是否于人院后一周内行腹腔穿刺引流术，将其分为APD组（66例）和非APD组（41例）。其中APD组依据穿刺时间分为0-2天（48h内）、3～5天和6～7天三个亚组。分析比较两组及APD各亚组间患者住院期间病死率、进阶率、住院时长、住院费用、器官衰竭及炎症状态等相关指标。结果非APD组有22例患者于4周内进阶行经皮穿刺置管引流（PCD）治疗，进阶率为53．7％，病死率为22．0％；APD组有21例患者于4周内进阶行PCD治疗，进阶率为31．8％，病死率为9．1％；APD组内0-2天亚组患者的进阶率为6．9％，患者住院其间病死率为0。与其他组相比，0～2天亚组患者不但进阶率和住院其间病死率明显降低，住院时长和住院费用也明显减少，而且住院后1周时炎性指标、器官功能衰竭状况以及疾病严重程度评分明显好转（P〈0．05）。结论APD可有效治疗伴有明显腹腔积液的SAP患者，48h内穿刺治疗可显著改善患者预后。48h内穿刺引流是APD治疗伴有大量腹腔积液SAP患者的最佳时间窗。
Objective To study the impact of early abdominal paracentesis drainage （APD） on the clinical course in patients with severe acute pancreatitis and massive peritoneal effusion. Methods From January 2012 to January 2017, 107 patients with severe acute pancreatitis treated at the Chengdu Military General Hospital were retrospective studied. According to whether the patients underwent abdominal paracentesis drainage within a week of hospital admission, they were divided into the APD group （n=66） and the Non - APD group （n=41）. The APD group was further subgrouped into the 0-2 d （within 48 h）, 3-5 d and 6 -7 d subgroups. The mortality rates, progression rates, length of stay, cost of stay, organ failure rates and inflammatory state of each subgroup of the APD were statistically analyzed and compared. Results 22 patients in the Non - APD group progressed in four weeks to require percutaneous catheter drainage （PCD）. The rate of progression was 53.7%, and the mortality rate was 22%. In the APD group, 21 patients underwent PCD treatment within 4 weeks. The rate of progression was 31.8% and the mortality rate was 9.1%. In the APD group, the progression rate for the patients in the 0-2 d subgroup was 6.9%, and the in-hospital mortality rate was 0. When compared with the other subgroups, the 0 to 2 d subgroup of patients had significantly lower progression and in- hospital mortality rates, lower hospitalization duration and hospitalization costs. These patients at 1 week after hospitalization also had significantly better inflammatory indexes, less incidence of organ failure and better disease severity scores （P〈0.05）. Conclusions The results confirmed the effectiveness of APD in treating patients with severe acute pancreatitis with significantperitoneal effusion. Puncture treatment within 48 hours significantly improved prognosis of patients. The best time window of APD treatment for patients with severe acute panereatitis with massive abdominal fluid is within 48 hours of hospitalization.
作者
苏江林
黄竹
孙红玉
汤礼军
Su Jianglin;Huang Zhu;Sun Hongyu;Tang Lijun(Department of Hepatobiliary Surgery,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2018年第10期692-697,共6页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金（81772001）
国家临床重点专科建设项目（41792113）
四川省科技计划（2015520229）
关键词
腹腔穿刺引流
重症急性胰腺炎
胰源性腹水
穿刺时机
Abdominal paracentesis drainage（APD）
Severe acute pancreatitis（SAP）
Pancreatitis associated abdominal fluid
Puncture timing
