本文選題：妊娠期 + 急性胰腺炎　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討年齡、孕次、孕期、病因、體重指數(shù)等對(duì)妊娠期合并急性胰腺炎嚴(yán)重程度的影響,及妊娠期合并急性胰腺炎對(duì)實(shí)驗(yàn)室檢查指標(biāo)和妊娠預(yù)后的影響。方法:回顧性分析四川省人民醫(yī)院2006年1月至2015年12月收治的60例妊娠期合并急性胰腺炎患者的臨床資料。根據(jù)急性胰腺炎診斷指南(2014年)標(biāo)準(zhǔn)嚴(yán)重程度分級(jí),分為輕癥、中重癥、重癥三組。并對(duì)年齡、孕次、孕期、發(fā)病原因(膽源性、高脂血癥性、其它)、體重指數(shù)、實(shí)驗(yàn)室檢查指標(biāo)(血清淀粉酶、尿淀粉酶、血清脂肪酶、超敏C反應(yīng)蛋白、血糖、血鈣、甘油三酯、谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、白蛋白、總膽紅素、直接膽紅素、堿性磷酸酶)、妊娠預(yù)后等資料進(jìn)行統(tǒng)計(jì)和分析。結(jié)果:1.一般情況比較:統(tǒng)計(jì)所有病例,患者發(fā)病年齡區(qū)間為17-40歲,其中初產(chǎn)婦19例(31.67%),經(jīng)產(chǎn)婦41例(68.33%);孕期分類:妊娠早期5例(8.33%),妊娠中期3例(5.00%),妊娠晚期52例(86.67%);疾病嚴(yán)重程度分類:輕癥34例(56.67%),中重癥14例(23.33%),重癥12例(20.00%);病因分類:膽源性35.00%(21/60)包含膽囊結(jié)石23.33%(14/60)、膽囊炎8.33%(5/60)、膽總管結(jié)石1.67%(1/60)、膽管炎1.67%(1/60),高脂血癥占33.33%(20/60),其它31.67%(19/60)包括飲食因素的10例(16.67%)、甲狀旁腺功能亢進(jìn)的3例(5.00%)和不明原因的6例(10.00%)。2.妊娠期合并急性胰腺炎的嚴(yán)重程度情況:(1)年齡、孕次、孕期對(duì)疾病嚴(yán)重程度影響:不同年齡、懷孕次數(shù)、孕期對(duì)疾病嚴(yán)重程度比較無顯著差異(P0.05)。(2)病因?qū)θ焉锲诤喜⒓毙砸认傺椎膰?yán)重程度影響:不同病因引起的疾病嚴(yán)重程度差異有統(tǒng)計(jì)學(xué)意義(P0.05);再經(jīng)組間兩兩比較,檢驗(yàn)水準(zhǔn)校正為α=0.017,膽源性病因組與高脂血癥病因組比較有顯著差異(P0.017);但膽源性病因組、高脂血癥病因組分別與其它病因組比較,發(fā)生不同嚴(yán)重程度疾病的情況無顯著差異(P0.017)。(3)體重指數(shù)對(duì)妊娠期合并急性胰腺炎嚴(yán)重程度影響:在正常、超重、I度肥胖組比較,三個(gè)不同嚴(yán)重程度組比較無顯著差異(P0.05);在Ⅱ度肥胖組中,三個(gè)不同嚴(yán)重程度組比較有顯著差異(p0.05);據(jù)體重指數(shù)等級(jí)相關(guān)分析顯示,隨著體重指數(shù)等級(jí)的增加,疾病嚴(yán)重程度也增加,呈現(xiàn)出正相關(guān)的關(guān)系(r=0.269)。(4)妊娠期合并急性胰腺炎對(duì)實(shí)驗(yàn)室指標(biāo)的比較:(1)一般血清生化指標(biāo):三組不同嚴(yán)重程度的妊娠合并急性胰腺炎在血清淀粉酶、尿淀粉酶、血清脂肪酶中比較無差異(p0.05);而三組患者在超敏c反應(yīng)蛋白、血糖、血鈣、甘油三酯水平均有顯著差異(p0.05),經(jīng)兩兩比較顯示,各組間均存在差異(p0.05);具體表現(xiàn)為,隨著妊娠合并急性胰腺炎嚴(yán)重程度的增加,超敏c反應(yīng)蛋白、血糖、甘油三酯均不斷增加,血鈣不斷降低。(2)肝功能指標(biāo):不同嚴(yán)重程度的妊娠期合并急性胰腺炎的谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、白蛋白指標(biāo)均存在統(tǒng)計(jì)學(xué)差異(p0.05),隨著病情嚴(yán)重程度的增加,谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶水平不斷增高,白蛋白水平不斷降低;雖然數(shù)據(jù)顯示隨著疾病病情加重,總膽紅素、直接膽紅素水平也呈現(xiàn)增高趨勢(shì),但經(jīng)兩兩比較分析顯示,總膽紅素、直接膽紅素水平僅在輕度組和重度組間存在差異(p0.05)。3.妊娠期合并急性胰腺炎對(duì)妊娠預(yù)后的影響:本研究中,無孕產(chǎn)婦死亡,圍產(chǎn)期兒有6例死亡。終止妊娠有25例(41.67%),2例妊娠早期患者人為選擇流產(chǎn)(3.33%);1例妊娠中期患者人為選擇引產(chǎn)(1.67%);22例選擇剖宮產(chǎn)(36.67%),其中11例胎兒達(dá)到足月而行剖宮產(chǎn),另外11例因治療期間胎兒宮內(nèi)發(fā)生窘迫征象行急診剖宮產(chǎn)。三個(gè)不同嚴(yán)重程度組在剖腹產(chǎn)、早產(chǎn)率方面比較無顯著意義(p0.05);輕癥組在足月順產(chǎn)率高于中重癥組、重癥組,差異有統(tǒng)計(jì)學(xué)意義(p0.05);不同嚴(yán)重程度的妊娠期合并急性胰腺炎,在死胎引產(chǎn)率、胎兒宮內(nèi)窘迫發(fā)生率、新生兒窒息發(fā)生率、死亡率方面比較有顯著差異(p0.05)。在合并重癥急性胰腺炎的孕婦中,胎兒宮內(nèi)窘迫、死胎、新生兒窒息乃至死亡風(fēng)險(xiǎn)均明顯增高。外科干預(yù)有11例,其中6例急性胰腺炎病情不重,術(shù)中未擾動(dòng)胰腺僅行腹腔引流;5例sap患者行胰周壞死組織清除和胰周引流術(shù),其中還有2例合并膽囊結(jié)石加行膽囊切除術(shù)和膽道探查術(shù)。結(jié)論:1.膽源性和高脂血癥是妊娠期合并急性胰腺炎的主要病因,膽源性妊娠期急性胰腺炎以輕癥為主,而高脂血癥更易導(dǎo)致中重癥甚至重癥急性胰腺炎。2.隨著體重指數(shù)等級(jí)的增加,妊娠期合并急性胰腺炎的嚴(yán)重程度也有加重的趨勢(shì)。3.隨著妊娠期合并急性胰腺炎病情分級(jí)加重,肝功能損害程度也有增加的趨勢(shì)。4.妊娠期合并重癥急性胰腺炎患者的胎兒宮內(nèi)窘迫、死胎、新生兒窒息乃至死亡的風(fēng)險(xiǎn)均明顯增高。5.在輕癥、中重癥妊娠期合并急性胰腺炎患者中,采用積極非手術(shù)治療,多能夠得到有效控制,預(yù)后情況較好;在重癥妊娠期合并急性胰腺炎患者中,除積極非手術(shù)治療外,若出現(xiàn)產(chǎn)科和外科干預(yù)指針時(shí)需要考慮手術(shù)治療,治療方式盡可能選擇剖宮產(chǎn),同時(shí)結(jié)合病情選用外科術(shù)式。
[Abstract]:Objective: To investigate the influence of age, pregnancy, pregnancy, etiological factor, body mass index on the severity of acute pancreatitis in pregnancy, and the effects of acute pancreatitis on laboratory examination and pregnancy prognosis. Methods: a retrospective analysis of 60 cases of pregnancy combined with acute pregnancy from January 2006 to December 2015. Clinical data of patients with pancreatitis. According to the standard severity grade of the acute pancreatitis diagnostic guide (2014), it is divided into light, medium, severe, three groups. The age, pregnancy, pregnancy, cause of disease (biliary, hyperlipidemia, other), body mass index, laboratory examination index (serum amylase, urine amylase, serum lipase, hypersensitivity C) The data of protein, blood sugar, blood calcium, triglyceride, glutamic aminotransferase, glutamic pyruvidase, albumin, total bilirubin, direct bilirubin, alkaline phosphatase, and pregnancy prognosis were statistically analyzed. Results: 1. general cases were compared: all cases were 17-40 years of age, of which 19 cases (31.67%) were primipara and 41 cases (68.3 3%): pregnancy classification: 5 cases in the early pregnancy (8.33%), 3 cases in the middle of pregnancy (5%), 52 cases of late pregnancy (86.67%); the classification of disease severity: 34 cases (56.67%), 14 cases (23.33%), serious 12 cases (20%); etiology classification: choledocholithiasis (21/60), cholecystitis (5/60), choledocholithiasis (1/60), gallbladder. 1.67% (1/60), hyperlipidemia, 33.33% (20/60), other 31.67% (19/60) including 10 cases of dietary factors (16.67%), 3 cases of hyperparathyroidism (5%) and 6 cases of unexplained (10%).2. pregnancy with acute pancreatitis: (1) age, pregnancy, and pregnancy severity of the disease: different age, pregnancy times There was no significant difference in the severity of the disease during pregnancy (P0.05). (2) the effect of the cause on the severity of acute pancreatitis in pregnancy: the difference in the severity of the disease caused by different causes was statistically significant (P0.05); the test level was a =0.017, and the group of biliary venereal diseases was compared with the cause of hyperlipidemia. There were significant differences (P0.017), but there was no significant difference between the cause of hyperlipidemia and other etiological groups (P0.017). (3) the influence of body mass index on the severity of acute pancreatitis in pregnancy: in the normal, overweight, and I obesity group, three different severity groups were compared There was no significant difference (P0.05); in the obese group, there were significant differences in three different severity groups (P0.05). According to BMI correlation analysis, the severity of disease increased with the increase of BMI (r= 0.269). (4) the ratio of acute pancreatitis to laboratory indexes during pregnancy. (1) general serum biochemical indexes: there was no difference in serum amylase, urine amylase and serum lipase (P0.05) in three groups of different severity of pregnancy combined with acute pancreatitis (P0.05), while in the three groups, there were significant differences in the level of hypersensitive C reaction protein, blood sugar, blood calcium and triglyceride (P0.05). The difference between each group showed that there was a difference between each group. Difference (P0.05); specifically, with the increase of acute pancreatitis in pregnancy, hypersensitivity C reactive protein, blood glucose, triglyceride were all increasing, and blood calcium decreased continuously. (2) liver function index: gluten aminotransferase, alanine aminotransferase and albumin index in different severity of pregnancy with acute pancreatitis P0.05, with the increase of the severity of the disease, the level of glutamic aminotransferase and alanine transaminase increased and the level of albumin decreased. Although the data showed that the level of total bilirubin and direct bilirubin increased with the disease aggravation, but the total bilirubin and direct bilirubin level were only mild after 22 comparison. The difference between the group and the severe group (P0.05).3. pregnancy combined with acute pancreatitis on the pregnancy prognosis: in this study, there were no maternal deaths and 6 perinatal deaths. There were 25 cases of termination of pregnancy (41.67%), 2 cases of early pregnancy induced abortion (3.33%); 1 cases of mid-term pregnancy induced abortion (1.67%); and 22 cases of cesarean section. 36.67%), 11 of them reached full term for cesarean section, the other 11 cases of fetal distress in the treatment of the fetus during the treatment of the emergency cesarean section. Three different severity groups in the caesarean section, the rate of premature delivery was not significant (P0.05); in the light disease group was higher than the middle of severe group, severe group, the difference was statistically significant (P0.05) There were significant differences in the incidence of fetal distress, fetal distress, neonatal asphyxia, and mortality (P0.05). In pregnant women with severe acute pancreatitis, the risk of fetal distress, stillbirth, neonatal asphyxia and even death was significantly higher in pregnant women with severe acute pancreatitis. There were 11 cases, of which 6 cases of acute pancreatitis were not serious, without abdominal drainage in the operation, 5 cases of SAP patients underwent peripancreatic necrotic tissue clearance and peripancreatic drainage, of which 2 cases combined cholecystectomy with cholecystectomy and biliary tract exploration. Conclusion: 1. cholelithiasis and hyperlipidemia are the main diseases associated with acute pancreatitis in pregnancy. Acute pancreatitis in GD is mainly light, while hyperlipidemia is more likely to cause severe or severe acute pancreatitis.2. with the increase of body mass index. The severity of acute pancreatitis in pregnancy also has a tendency to aggravate the severity of.3. with the severity of acute pancreatitis in pregnancy and the degree of liver dysfunction. There is also an increase in the risk of fetal distress, stillbirth, asphyxia and even death of the patients with severe acute pancreatitis in.4. pregnancy. The risk of.5. in the patients with severe acute pancreatitis is significantly higher in patients with severe pregnancy and acute pancreatitis, with active non operative treatment, more effective control, better prognosis, and severe pregnancy. In patients with acute pancreatitis, in addition to active nonsurgical treatment, surgical treatment should be considered if the indications of obstetric and surgical intervention appear. The treatment of caesarean section should be chosen as far as possible, and the surgical procedure is selected in combination with the condition of the disease.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.255

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3 任sバ，

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