早期通便、引流治疗重症急性胰腺炎腹腔高压的效果观察

王强; 唐才喜; 冯斌; 杨凯庆; 贺明连; 赵志坚

doi:10.3969/j.issn.1001-5256.2017.01.023

早期通便、引流治疗重症急性胰腺炎腹腔高压的效果观察

DOI: 10.3969/j.issn.1001-5256.2017.01.023

株洲市中心医院肝胆胰外科

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中图分类号: R576
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出版历程
- 出版日期: 2017-01-20

Clinical effect of early bowel-relaxing treatment and drainage in treatment of severe acute pancreatitis with intra-abdominal hypertension

Department of Hepatopancreatobiliary Surgery, Zhuzhou Central Hospital, Zhuzhou, Hunan 412000, China

摘要

摘要:
目的探讨早期通便、引流对重症急性胰腺炎（SAP）治疗的效果。方法回顾性分析株洲市中心医院肝胆胰外科2009年1月-2015年1月收治的52例SAP患者的临床资料,分为常规治疗组（22例）和通便引流组（30例）。比较两组2周内多器官功能不全综合征及腹腔间隔室综合征发生率、腹内压降至15 cm H2O以下时间、胃肠功能恢复时间、胰腺感染率和病死率的差异。两组间计量资料比较采用独立样本t检验;计数资料比较采用χ2检验。结果与常规治疗组相比,早期通便引流组患者2周内多器官功能不全综合征及腹腔间隔室综合征发生率显著降低（31.8%vs 10.0%,22.7%vs 3.3%,χ2值分别为3.89、4.68,P值分别为0.049、0.031）,胰腺感染率及病死率显著下降（40.9%vs 13.3%,22.7%vs 3.3%,χ2值分别为5.15、4.68,P值分别为0.023、0.031）。与常规治疗组相比,早期通便引流组患者腹内压降至15 cm H2O以下时间[（4.7±1.0）d vs（8.3±0.9）d]、肠鸣音[（3.0±0.5）d vs（6.5±0.9）d]及排气排便恢复时间[（3.8±0...
- 胰腺炎,急性坏死性 /
- 引流术 /
- 通便 /
- 治疗结果
Abstract:
Objective To investigate the clinical effect of early bowel- relaxing treatment and drainage in the treatment of severe acute pancreatitis( SAP). Methods A retrospective analysis was performed for the clinical data of 52 patients with SAP who were admitted to Department of Hepatopancreatobiliary Surgery,Zhuzhou Central Hospital,from January 2009 to January 2015,and these patients were divided into conventional treatment group with 22 patients and early bowel- relaxing / drainage group with 30 patients. The incidence of multiple organ dysfunction syndrome and abdominal compartment syndrome within 2 weeks,time to intra- abdominal pressure reduced to below 15 cm H2 O,time to gastrointestinal function recovery,pancreatic infection rate,and mortality rate were compared between the two groups. The independent samples t- test was used for comparison of continuous data between the two groups,and the chi- square test was used for comparison of categorical data. Results Compared with the conventional treatment group,the early bowel- relaxing / drainage group had significant reductions in the incidence rates of multiple organ dysfunction syndrome( 31. 8% vs 10. 0%,χ2= 3. 89,P = 0. 049) and abdominal compartment syndrome( 22. 7% vs 3. 3%,χ2= 4. 68,P = 0. 031) within 2 weeks,pancreatic infection rate( 40. 9% vs 13. 3%,χ2= 5. 15,P= 0. 023),and mortality rate( 22. 7% vs 3. 3%,χ2= 4. 68,P = 0. 031). Compared with the conventional treatment group,the early bowel- relaxing / drainage group had significantly shortened time to intra- abdominal pressure reduced to below 15 cm H2 O,time to bowel sound recovery,and time to the recovery of passing of flatus and defecation( t = 1. 02,6. 67,and 2. 13,all P < 0. 01). Conclusion In the early stage of SAP,bowel- relaxing treatment and drainage can effectively reduce intra- abdominal hypertension,protect vital organ function,alleviate the condition of SAP,reduce the incidence of complications,and thus significantly improve the prognosis of SAP.
- pancreatitis /
- acute necrotizing /
- drainage /
- relaxing bowels

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