摘要目的 探讨内科综合治疗在重症急性胰腺炎(SAP)救治中的价值.方法 回顾性总结长海医院消化内科2000年1月至2011年12月收治的931例(共1064例次)患者资料.分析SAP的发病诱因、病情评分、并发症、治疗措施、疗效及费用等.结果 931例患者中,男性559例,女性372例,平均年龄(51±15)岁.胆源性为SAP最主要的发病诱因(58.3％),其次是高脂饮食(31.2％)、高脂血症(13.6％)和饮酒(7.1％).入院时Balthazar CT评分D级以上者占95.5％,Ranson评分≥3分者占26.0％,APACHEⅡ评分≥8分者占30.1％.42.7％的SAP患者合并全身炎症反应综合征(SIRS),24.0％合并急性肺损伤或急性呼吸窘迫综合征,8.1％合并急性肾损伤,5.4％出现休克或心衰,3.2％合并急性肝损伤,1.0％出现弥散性血管内凝血.其他并发症包括腹腔出血17例、假性囊肿出血9例、胰周脓肿78例和消化道瘘33例.主要治疗措施包括辅助呼吸、血液滤过、腹腔灌洗、穿刺引流、营养支持及内镜介入和手术治疗.院内病死25例(2.3％),放弃治疗出院36例(3.4％),总体抢救成功率为94.3％.平均住院天数为(23.7±19.2)d,平均住院费用为5.23万元.结论 建立以内科综合治疗为基础、以脏器功能维护为重点、以微创介入为手段的综合救治模式有助于提高SAP的救治成功率,值得进一步推广.

abstractsObjective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.