本文選題：超聲引導　切入點：胰腺炎　出處：《中國老年學雜志》2017年14期 　論文類型：期刊論文

【摘要】：目的研究老年重癥急性胰腺炎早期治療中超聲引導下經(jīng)皮穿刺置管灌洗引流對臨床療效及實驗室指標的影響。方法選取46例老年重癥急性胰腺炎患者,按隨機數(shù)字表法將其分為對照組(n=22)和研究組(n=24)。其中對照組患者采用常規(guī)保守治療,而研究組患者采用超聲引導下經(jīng)皮穿刺置管灌洗引流治療。對比兩組兩組患者心率、體溫、癥狀、體征(發(fā)熱、嘔吐、腹脹、腹痛、肌緊張、反跳痛、腹部壓痛及發(fā)熱)消失時間、總住院天數(shù)及恢復(fù)飲食天數(shù)。統(tǒng)計胰腺假性囊腫、胰周膿腫、代謝紊亂、早期多臟器功能障礙綜合征(MODS)、休克、急性心力衰竭、胰性腦病、急性腎功能衰竭、急性呼吸窘迫綜合征等并發(fā)癥的發(fā)生情況。動態(tài)觀察治療前后腹部超聲檢查改變。觀察兩組患者治療前、治療后(48~72 h)的尿淀粉酶、血淀粉酶、血鈣、血糖、血白細胞計數(shù)等。結(jié)果 29例研究組患者均成功完成治療,引流管放置4~8根,治療時間45~96 min,術(shù)后無嚴重并發(fā)癥如胃腸道損傷、大出血等發(fā)生,術(shù)后患者腹部癥狀明顯減輕或有所減輕。其中成功置管23例,經(jīng)引流管引流出渾濁或血性腹腔積液,因壞死組織黏稠,引流不暢,引流管阻塞后加壓沖洗側(cè)口管無效者6例,進行重新置管后腹腔積液均成功引出。術(shù)后灌洗引流時間6~23 d。研究組患者的心率、體溫、癥狀體征消失時間、總住院天數(shù)、血淀粉酶恢復(fù)正常天數(shù)和恢復(fù)飲食天數(shù)均明顯低于對照組差異具有統(tǒng)計學意義(P0.05),對照組22例患者中保守治療后痊愈出院10例,7例好轉(zhuǎn),3例進行積極非手術(shù)治療后病情持續(xù)惡化,中轉(zhuǎn)手術(shù)后好轉(zhuǎn),2例患者出現(xiàn)嚴重并發(fā)癥,其中1例患者死于胰性腦病,1例患者死于MODS。研究組24例患者中引流效果好,痊愈出院18例,5例好轉(zhuǎn),無中轉(zhuǎn)手術(shù),1例患者出現(xiàn)嚴重并發(fā)癥MODS,搶救無效死亡。對照組患者治療有效率為77.3%,研究組患者治療有效率為95.8%,兩組患者治療有效率對比差異具有統(tǒng)計學意義(χ2=5.668,P0.05)。治療后兩組患者的胰腺體積均有不同程度的縮小。兩組患者治療前尿淀粉酶、血淀粉酶、血鈣、血糖和血白細胞計數(shù)等指標差異無統(tǒng)計學意義(P0.05)。治療后,兩組患者各項指標均出現(xiàn)顯著差異(P0.05),研究組患者血鈣水平明顯高于治療前(t=4.630,P0.05),尿淀粉酶、血淀粉酶、血糖、血白細胞計數(shù)等指標均明顯低于治療前(t=5.241,8.601,5.918,6.020,P均0.05)。結(jié)論 SAP早期治療中采用超聲引導下經(jīng)皮穿刺置管灌洗引流治療可有效避免開放性外科手術(shù)的創(chuàng)傷及出現(xiàn)的并發(fā)癥,具有有效、安全的特點,在早期積極進行SAP非手術(shù)綜合治療過程中應(yīng)密切關(guān)注并發(fā)癥的發(fā)生和有無胰腺感染,對有手術(shù)指征的患者應(yīng)及時進行手術(shù)治療,避免延誤病情。
[Abstract]:Objective to study the effect of ultrasonic guided percutaneous catheter lavage and drainage on clinical efficacy and laboratory indexes in the early treatment of severe acute pancreatitis in the elderly. Methods 46 elderly patients with severe acute pancreatitis were selected. The patients in the control group were treated with conventional conservative therapy, while the patients in the study group were treated with percutaneous catheter lavage and drainage under the guidance of ultrasound. The heart rate and body temperature of the two groups were compared. Symptoms, signs (fever, vomiting, abdominal distension, abdominal pain, muscle tension, rebound pain, abdominal tenderness and fever) disappeared, total days of hospitalization and days of recovery of diet. Statistics of pancreatic pseudocyst, peripancreatic abscess, metabolic disorder, Early multiple organ dysfunction syndrome mods, shock, acute heart failure, pancreatic encephalopathy, acute renal failure, Dynamic observation of the changes of abdominal ultrasound before and after treatment. The urine amylase, serum amylase, serum calcium, blood glucose were observed before and after treatment in both groups. Results all the 29 patients in the study group were successfully treated with 48 drainage tubes for 4596 minutes. There were no serious postoperative complications such as gastrointestinal injury, massive hemorrhage, and so on. The abdominal symptoms of the patients were relieved or alleviated, of which 23 cases were successfully placed, and 6 cases were treated with turbid or bloody celiac effusion drainage due to necrotic tissue viscosity, obstruction of drainage tube, failure of pressure flushing side orifice tube. The postoperative lavage and drainage time was 6 ~ 23 days. The heart rate, body temperature, symptoms and signs disappeared, and the total hospitalization days, the heart rate, body temperature, symptoms and signs of the patients in the study group were disappeared. The days of serum amylase recovery and diet recovery were significantly lower than those of the control group (P 0.05). In the control group, 10 cases recovered after conservative treatment, 7 cases recovered and 3 cases continued to deteriorate after active non-operative treatment. There were serious complications in 2 patients who had improved after the transfer operation, 1 case died of pancreatic encephalopathy and 1 case died of MODS.The study group had good drainage effect among 24 cases, 18 cases recovered and 5 cases improved. The effective rate of treatment in the control group was 77.3 and the effective rate of the study group was 95.8.The difference between the two groups was statistically significant (蠂 2 5.668 P 0.05). After treatment, the pancreatic volume in both groups was reduced to varying degrees. There was no significant difference in serum amylase, calcium, blood glucose and white blood cell count between the two groups. After treatment, there were significant differences in all the indexes between the two groups. The serum calcium level of the patients in the study group was significantly higher than that of the patients in the study group before and after treatment, and the levels of serum amylase, amylase and amylase in urine were significantly higher than those in the study group. Blood glucose and white blood cell count were significantly lower than those before treatment. Conclusion Ultrasound-guided percutaneous catheter lavage and drainage can effectively avoid trauma and complications in open surgery. It is effective and safe. We should pay close attention to the occurrence of complications and pancreatic infection in the early non-operative comprehensive treatment of SAP. The patients with surgical indications should be treated in time to avoid delay.
【作者單位】： 浙江大學附屬第一醫(yī)院超聲醫(yī)學科;
【基金】：杭州市衛(wèi)生局課題(No.2013A13)
【分類號】：R445.1;R576

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