论文部分内容阅读
目的 分析左旋门冬酰胺酶 (L ASP)诱发急性胰腺炎的临床特点 ,以利早期诊断和治疗。方法 对 1996～ 2 0 0 1年应用L ASP进行化疗方案治疗的 675例次中发生急性胰腺炎的 19例的临床特点、血液学和影象学检查及治疗预后作了总结分析。结果 L ASP诱发急性胰腺炎的发生率为 2 8%。临床表现中有腹痛 17例 ,伴恶心 17例、呕吐 16例 ;发烧 13例、腹胀 13例、休克 11例。首发症状中主要为腹痛 ,其次为休克。血液检查 19例中血淀粉酶升高 16例、高血糖 11例、低血钠 11/18例、低血钙 9/18例、低蛋白血症 8/16例、酸中毒 7/18例及肾功不良 3例 ,凝血功能异常 10 /16例。合并症中有肝损害或脂肪肝、腹膜炎、感染。B超或CT检查 :16/18例 (89% )有异常。抢救休克和抑制胰酶分泌是最重要的非手术治疗措施 ;出血坏死性胰腺炎及早手术。 19例胰腺炎中 12例治愈 ,其中 10例水肿型均痊愈 ;9例出血坏死型中 7例死于休克。结论 结合L ASP的用药史 ,监测病人腹痛或休克表现 ,检测血淀粉酶及腹部B超可以使早期诊断成为可能。抢救休克、抑制胰酶分泌及手术是最主要的治疗措施
Objective To analyze the clinical features of acute pancreatitis induced by L-asparaginase (L ASP) in order to facilitate the early diagnosis and treatment. Methods The clinical features of 19 cases with acute pancreatitis in 675 cases treated with L-ASP chemotherapy from 1996 to 2001 were analyzed. The hematology and imaging findings and the prognosis of treatment were analyzed. Results The incidence of acute pancreatitis induced by L ASP was 28%. Clinical manifestations of abdominal pain in 17 cases, with nausea in 17 cases, vomiting in 16 cases; fever in 13 cases, abdominal distension in 13 cases, shock in 11 cases. The first symptom was abdominal pain, followed by shock. Blood tests in 19 cases of elevated amylase in 16 cases, hyperglycemia in 11 cases, 11/18 cases of hyponatremia, hypoxia 9/18 cases, hypoproteinemia 8/16 cases, 7/18 cases of acidosis and 3 cases of renal dysfunction, coagulation disorders 10/16 cases. Complications of liver damage or fatty liver, peritonitis, infection. B ultrasound or CT examination: 16/18 cases (89%) have abnormalities. Rescue shock and inhibition of pancreatic enzyme secretion is the most important non-surgical treatment; hemorrhagic necrotizing pancreatitis and early surgery. Of the 19 cases of pancreatitis, 12 cases were cured, of which 10 cases of edema were cured; 9 cases of hemorrhagic necrosis in 7 cases died of shock. Conclusion The combination of L ASP medication history, monitoring of patients with abdominal pain or shock performance, detection of blood amylase and abdominal B ultrasound can make early diagnosis possible. Rescue shock, inhibition of pancreatic enzyme secretion and surgery is the most important treatment