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目的探讨胸腔积液、高脂血症与重症急性胰腺炎(SAP)早期诊断的关系。方法 2010年1月-2014年3月对入院24 h内的120例急性胰腺炎患者按2013年《中国急性胰腺炎诊治指南》的诊断标准分为SAP组(68例)和轻症急性胰腺炎(MAP)组(52例)。两组均行胸腹部CT及血脂分析检查,记录胸腔积液、高脂血症以及胸腔积液并高脂血症与SAP发病例数、病死率、腹水、肝功能不全、胰腺假性囊肿的关系。结果 SAP组与MAP组胸腔积液分别为57例(83.8%)和12例(23.1%),高脂血症分别为52例(76.5%)和17例(32.7%),胸腔积液并高脂血症分别为47例(69.1%)和7例(13.5%),差异有统计学意义(P<0.001)。SAP组患者中,是否并发胸腔积液者病死率、胰腺假性囊肿发生率差异无统计学意义(P>0.05),并发胸腔积液者腹水、肝功能不全发生率发生率高于无胸腔积液者(P<0.05);是否合并高脂血症者病死率、胰腺假性囊肿发生率差异无统计学意义(P>0.05),合并高脂血症者腹水和肝功能不全发生率均高于未合并高脂血症者(P<0.05);是否同时合并胸腔积液和高脂血症者胰腺假性囊肿发生率差异无统计学意义(P>0.05),同时合并胸腔积液和高脂血症者病死率、腹水发生率、肝功能不全发生率均高于未同时合并胸腔积液和高脂血症者(P<0.05)。结论胸腔积液、高脂血症与SAP发生有密切关系,同时还与部分并发症有关,检测这两项指标,对SAP早期诊断及并发症的早期干预有意义。
Objective To investigate the relationship between pleural effusion, hyperlipidemia and early diagnosis of severe acute pancreatitis (SAP). Methods From January 2010 to March 2014, 120 patients with acute pancreatitis within 24 hours after admission were divided into SAP group (68 cases) and mild acute pancreatitis according to the diagnostic criteria of “Guide to Diagnosis and Treatment of Acute Pancreatitis in China” (MAP) group (52 cases). Both groups underwent chest and abdomen CT and blood lipid analysis examination, recording pleural effusion, hyperlipidemia and pleural effusion with hyperlipidemia and SAP incidence of cases, mortality, ascites, liver insufficiency, pancreatic pseudocyst relationship. Results The pleural effusion in SAP group and MAP group were 57 (83.8%) and 12 (23.1%) respectively. The hyperlipidemia was 52 (76.5%) and 17 (32.7% There were 47 cases (69.1%) and 7 cases (13.5%) of the hyperlipidemia respectively, the difference was statistically significant (P <0.001). There was no significant difference in the incidence of pancreatic pseudocyst between the patients with SAP and those with pleural effusion (P> 0.05). The incidence of ascites and hepatic insufficiency in patients with pleural effusion was higher than that without pleural effusion (P <0.05). There was no significant difference in the incidence of pancreatic pseudocyst between the patients with and without hyperlipidemia (P> 0.05). The rates of ascites and hepatic insufficiency in patients with hyperlipidemia were all high (P <0.05). There was no significant difference in the incidence of pancreatic pseudocysts between patients with pleural effusion and hyperlipidemia (P> 0.05). Concurrent with pleural effusion and high Fatty lipids mortality, ascites incidence, hepatic insufficiency were higher than those without concurrent pleural effusion and hyperlipidemia (P <0.05). Conclusions Pleural effusion, hyperlipidemia and SAP are closely related, but also with some complications, detection of these two indicators, SAP early diagnosis and complications of early intervention meaningful.