本文選題：妊娠期合并急性胰腺炎　切入點(diǎn)：病因　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的急性胰腺炎(Acute pancreatitis,AP)是較常見(jiàn)的一種急腹癥,但是發(fā)生在妊娠期的AP在臨床中不多見(jiàn),妊娠期合并AP的病因較多,不僅包括膽道疾病、高脂血癥及暴飲暴食等常見(jiàn)因素,還有一些少見(jiàn)因素如藥物、手術(shù)等,也可導(dǎo)致AP。妊娠期合并AP起病急、發(fā)展快、死亡率高,如果治療不及時(shí),可引起母體低血容量、感染性休克、水電解質(zhì)酸堿平衡紊亂、多器官功能障礙綜合征(multiple organs dysfunction syndrome,MODS),甚至導(dǎo)致死亡。對(duì)于母體來(lái)說(shuō),可能會(huì)出現(xiàn)流產(chǎn)、早產(chǎn)等不良后果,對(duì)胎兒的影響是可能出現(xiàn)宮內(nèi)窘迫、宮內(nèi)死胎等結(jié)局。本研究回顧性分析妊娠期急性胰腺炎的臨床特征,以期增強(qiáng)對(duì)妊娠期合并急性胰腺炎的認(rèn)識(shí),有助于及早確診并及時(shí)治療,改善妊娠期急性胰腺炎的預(yù)后。資料和方法回顧性分析鄭州大學(xué)第一附屬醫(yī)院2008年2月至2016年4月收治的587例急性胰腺炎(Acute pancreatitis,AP)患者的臨床資料,其中65例妊娠期急性胰腺炎患者納入研究組,522例非妊娠期急性胰腺炎女性患者為對(duì)照組,對(duì)比分析妊娠期合并急性胰腺炎(Acute pancreatitis in pregnancy,APIP)發(fā)病的病因、臨床特點(diǎn)、并發(fā)癥及誤診原因。結(jié)果1.病因分析:引起妊娠期急性胰腺炎的相關(guān)因素中,研究組的主要病因有:1)膽石癥和膽道疾病占44.6%(29/65),2)高脂血癥為24.6%(16/65),3)暴飲暴食及飲酒為18.5%(12/65),4)其他因素(如甲狀旁腺功能亢進(jìn)、感染、藥物、手術(shù)等)占12.5%(8/65);對(duì)照組常見(jiàn)的主要病因?yàn)?1)膽道系統(tǒng)疾病占53.4%(279/522),2)高脂血癥為21.3%(111/522),3)暴飲暴食和飲酒為16.3%(85/522),4)其他因素占9.0%(47/522)。實(shí)驗(yàn)室檢查中:研究組血脂水平明顯高于對(duì)照組。研究結(jié)果表明,在引起AP的病因分析中,研究組和對(duì)照組中膽道系統(tǒng)疾病和高脂血癥、暴飲暴食之間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);研究組和對(duì)照組中血脂水平差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.臨床特點(diǎn):研究組中輕癥急性胰腺炎所占的比例為63.1%(41/65),中重癥急性胰腺炎的比例為36.9%(24/65);對(duì)照組中發(fā)生輕癥AP的比例是78.4%(409/522),中重癥AP占21.6%(113/522)。妊娠期合并急性胰腺炎患者中,發(fā)生重癥急性胰腺炎的比例明顯高于非妊娠期發(fā)生重型急性胰腺炎的比例。(P0.05)。3.誤診率:研究組起病時(shí)誤診的病例數(shù)為39例,誤診率達(dá)60.0%,其中誤診為早產(chǎn)28例,胎盤(pán)早剝2例,急性胃腸炎3例,急性闌尾炎4例,急性膽囊炎2例;對(duì)照組的誤診率為19.3%(101/522),分別被誤診為急性闌尾炎18例、急性胃腸炎30例,急性膽囊炎19例,腸梗阻34例。妊娠期急性胰腺炎的誤診率明顯高于普通患者AP(P0.05)。4.妊娠期合并急性胰腺炎對(duì)母親及胎兒的影響(治療結(jié)局):研究組有2例因膽囊結(jié)石行膽囊切除術(shù),5例因膽管結(jié)石行經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)(Endoscopic Retrograde Cholangiopancreatography,ERCP),3例行血漿置換,2例患者死亡(死亡率3.1%);對(duì)照組中522例患者中365例經(jīng)保守治療后好轉(zhuǎn),57例因膽囊結(jié)石行膽囊切除術(shù),92例因膽管結(jié)石行ERCP術(shù),有8例因嚴(yán)重并發(fā)癥死亡(死亡率1.5%)。對(duì)母體生育方面,研究組31例(47.7%)行剖宮產(chǎn),11例(16.9%)自然分娩,7例先兆早產(chǎn)(10.8%),6例(9.2%)流產(chǎn),8例繼續(xù)妊娠。對(duì)胎兒影響方面,7例胎兒死亡(5例宮內(nèi)死胎,2例出生后因重度窒息死亡),死亡率為10.8%;出生的嬰兒健康存活。結(jié)論1.妊娠期合并急性胰腺炎和非妊娠期急性胰腺炎的病因均主要為膽源性疾病和高脂血癥,而且APIP的甘油三脂水平明顯高于普通AP。因此,對(duì)于以前有高脂血癥以及有膽道系統(tǒng)疾病的患者,應(yīng)定期做好產(chǎn)前診斷和檢查,更要注意合理飲食,并對(duì)相關(guān)疾病及早診治,以便早期預(yù)防,從而降低妊娠期急性胰腺炎的發(fā)病率。2.由于妊娠期急性胰腺炎患者的臨床表現(xiàn)不典型,且部分醫(yī)師對(duì)妊娠期合并AP的認(rèn)識(shí)不足,更容易導(dǎo)致漏診、誤診,提高誤診率。因此,臨床上要高度警惕妊娠期合并AP的患者,依據(jù)病人的臨床表現(xiàn)、實(shí)驗(yàn)室檢查以及影像學(xué)檢查,早期診斷,進(jìn)一步做到早期治療,以降低該病的漏診、誤診率;必要時(shí)積極請(qǐng)相關(guān)科室會(huì)診以協(xié)助診治,減少不良結(jié)局的發(fā)生。3.妊娠合并AP多見(jiàn)于妊娠中晚期,若疾病不及時(shí)控制,可嚴(yán)重威脅母嬰安全,且患者個(gè)體差異較大,因此APIP治療上在強(qiáng)調(diào)“個(gè)體化治療”的同時(shí)[1],還要按不同病因及病程分期應(yīng)用不同的治療方案。
[Abstract]:Objective to acute pancreatitis (Acute pancreatitis AP) is a kind of common acute abdomen during pregnancy, but the occurrence of AP in clinical rare, the etiology of pregnancy complicated with AP, including not only the common factors of biliary tract disease, hyperlipidemia and overeating, there are some rare factors such as drugs, surgery etc. AP., can also lead to pregnancy AP acute onset, rapid development, the mortality rate is high, if not timely treatment, can cause maternal hypovolemia, septic shock, water electrolyte and acid-base balance disorders, multiple organ dysfunction syndrome (MODS multiple organs dysfunction syndrome), and even lead to death. For mother, may miscarriage, premature birth and other adverse consequences, the effects on the fetus is possible fetal distress, fetal death and other outcomes. This study retrospectively analyzed the clinical features of acute pancreatitis during pregnancy, in order to enhance pregnancy together Understanding and acute pancreatitis, contribute to the early diagnosis and timely treatment, improve the prognosis of acute pancreatitis during pregnancy. Materials and methods of analysis of 587 cases of acute pancreatitis in the First Affiliated Hospital of Zhengzhou University from February 2008 to April 2016 were reviewed (Acute, pancreatitis, AP) in patients with clinical data, including 65 cases of acute pancreatitis during pregnancy were included in the study group, 522 cases of female non pregnant patients with acute pancreatitis as control group, comparative analysis of pregnancy complicated with acute pancreatitis (Acute pancreatitis in pregnancy, APIP) the clinical characteristics, etiology, complications and causes of misdiagnosis. Results: 1. etiological analysis of related factors of acute pancreatitis during pregnancy cause, main causes of study group are: 1) cholelithiasis and biliary disease accounted for 44.6% (29/65), 2) hyperlipidemia was 24.6% (16/65), 3) binge eating and drinking for 18.5% (12/65), 4) and other factors (such as thyroid Drug parathyroid hyperfunction, infection, surgery, etc.) accounted for 12.5% (8/65); the control group of common disease mainly because: 1) biliary diseases accounted for 53.4% (279/522), 2) hyperlipidemia was 21.3% (111/522), 3) overeating and drinking was 16.3% (85/522), other 4) factors accounted for 9% (47/522). Laboratory examination: a study of lipid levels was significantly higher than the control group. The results of the study show that, in the cause analysis of AP in the study of biliary diseases and hyperlipidemia group and control group, overeating were no significant differences between (P0.05); the difference was statistically significant study on the serum lipid level group and the control group (P0.05.2.): a study of clinical features of mild acute pancreatitis group in the proportion of 63.1% (41/65), in the proportion of severe acute pancreatitis was 36.9% (24/65); mild AP occurred in the control group were 78.4% (409/522), severe AP accounted for 21.6% (113/522) during pregnancy. In patients with acute pancreatitis, severe acute pancreatitis was higher than that of non occurrence of severe acute pancreatitis during pregnancy. The ratio of (P0.05).3. misdiagnosis rate: the study group was misdiagnosed cases for 39 cases, the misdiagnosis rate was 60%, among which the misdiagnosis of 28 cases of premature delivery, 2 cases of placental abruption, 3 cases of acute gastroenteritis, 4 cases of acute appendicitis, 2 cases of acute cholecystitis; control group, the misdiagnosis rate was 19.3% (101/522), 18 cases were misdiagnosed as acute appendicitis, 30 cases of acute gastroenteritis, 19 cases of acute cholecystitis, 34 cases of intestinal obstruction. The misdiagnosis of acute pancreatitis during pregnancy was significantly higher than that of ordinary patients with AP (P0.05) effect on maternal and fetal.4. in pregnancy complicated with acute pancreatitis (outcome): study group 2 cases of cholecystectomy, 5 cases with biliary calculi underwent endoscopic retrograde cholangiopancreatography (Endoscopic Retrograde, Cholangiopancreatography, ERCP, 3) Routine plasmapheresis, 2 patients died (mortality 3.1%); the control group in 522 cases, 365 cases were cured by conservative treatment, 57 cases of cholecystectomy, 92 cases with biliary calculi underwent ERCP, 8 cases died of severe complications (mortality 1.5%). On the maternal family. The study group of 31 cases (47.7%) underwent cesarean section, 11 cases (16.9%) of natural childbirth, 7 cases of threatened premature labor (10.8%), 6 cases (9.2%) of 8 cases of abortion, pregnancy continued. Effects on the fetus, fetal death in 7 cases (5 cases of intrauterine fetal death, 2 cases of severe asphyxia after birth death). The mortality rate was 10.8%; a baby born healthy survival. Conclusion the causes of pregnancy complicated with acute pancreatitis and 1. non pregnant women with acute pancreatitis were mainly biliary diseases and hyperlipidemia, and APIP glycerin three fat levels were significantly higher than that of ordinary AP. therefore have hyperlipidemia and patients with biliary tract disease in previously should Do regular prenatal diagnosis and examination, should pay more attention to the reasonable diet, and the diseases related to early prevention, early diagnosis and treatment, so as to reduce the incidence of acute pancreatitis during pregnancy rate of.2. due to the clinical manifestations of patients with acute pancreatitis during pregnancy is not typical, and some doctors understanding of pregnancy complicated with AP, more easily lead to misdiagnosis. To improve the rate of misdiagnosis, misdiagnosis. Therefore, patients should be alert to pregnancy in patients with AP, according to the clinical manifestations, laboratory examination and imaging examination, early diagnosis, early treatment and further, to reduce the misdiagnosis, the misdiagnosis rate; if necessary please actively consultations to assist in diagnosis and treatment, reduce the the incidence of adverse outcomes of pregnancy.3. AP in pregnancy, if the disease can not control, a serious threat to the safety of mother and child, and with individual differences, because of this APIP treatment on" [1], at the same time as individualized therapy, also applies different treatments according to the different etiological and course stages.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.255

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳霞;趙宏賢;王忠瓊;李昌平;;妊娠期急性胰腺炎32例臨床特點(diǎn)分析[J];瀘州醫(yī)學(xué)院學(xué)報(bào);2015年05期

2 王春友;李非;趙玉沛;苗毅;楊尹默;;急性胰腺炎診治指南(2014)[J];中國(guó)實(shí)用外科雜志;2015年01期

3 高繼燕;;妊娠期急性胰腺炎[J];中國(guó)藥物與臨床;2013年07期

4 張冬林;黃毅;嚴(yán)麗;Amy Phu;冉曉;李樹(shù)生;;Thirty-eight Cases of Acute Pancreatitis in Pregnancy: A 6-year Single Center Retrospective Analysis[J];Journal of Huazhong University of Science and Technology(Medical Sciences);2013年03期

5 張和;孫備;;急性胰腺炎分類標(biāo)準(zhǔn)發(fā)展變遷與現(xiàn)狀[J];中國(guó)實(shí)用外科雜志;2013年04期

6 莊曉明;劉莉冬;;妊娠合并急性胰腺炎的臨床分析[J];實(shí)用臨床醫(yī)學(xué);2013年02期

7 朱鴻;別穎路;;急性胰腺炎的4種常用實(shí)驗(yàn)室指標(biāo)的評(píng)價(jià)[J];中國(guó)實(shí)驗(yàn)診斷學(xué);2012年01期

8 張廣軍;劉寶華;;雌激素對(duì)胃腸動(dòng)力的影響[J];中華內(nèi)分泌外科雜志;2011年03期

9 Capecomorin S Pitchumoni;Balaji Yegneswaran;;Acute pancreatitis in pregnancy[J];World Journal of Gastroenterology;2009年45期

10 熊炬;張彥;周容;;62例妊娠合并急性胰腺炎不同時(shí)期的臨床特征及結(jié)局分析[J];實(shí)用婦產(chǎn)科雜志;2009年06期

，

本文編號(hào)：1579659