【作者】 陶伟；

【导师】 昝建宝；

【作者基本信息】 安徽医科大学 ， 外科学（普外）， 2022， 硕士

【摘要】 目的探究不同腹腔穿刺引流时机对中度重症胰腺炎(Moderate severe acute pancreatitis,MSAP)伴腹水患者的C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitionin,PCT)、白细胞(White blood cell,WBC)、白介素6(Inter-Leukin 6,IL-6)、肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)等实验室指标及住院天数、住院费用、病死率、进阶率、器官功能障碍等临床指标的影响,选择出MSAP伴腹水患者的最佳穿刺时机。方法收集统计在2019年9月到2021年5月进入安徽医科大学附属安庆医学中心在医院里进行治疗的MSAP患者84例,其中28例于发病0-3天内行APD治疗,男性12例,女性16例;年龄32-75岁,平均年龄(56.32±13.31)岁。28例于发病4-7天内行APD治疗,男性13例,女性15例;年龄31-75岁,平均年龄(56.46±12.16)岁。其余28例于发病一周内行非APD保守治疗,男性12例,女性16例,年龄31-72岁,平均年龄(56.50±13.48)岁。发病0-3天内APD组,发病4-7天内APD组及非APD组患者性别、年龄比较差异无统计学意义(P<0.05)。分别收集各组患者于入院后第1,7,14天的血液CRP、WBC、PCT、IL-6、TNF-α的炎症指标,在对患者的住院天数、住院费用临床数据还有病死率、进阶率、器官衰竭等相关数据进行收集整理后,利用统计学工具分析,比较各个组组间的差异。结果发病0-3天内APD组患者病死率为0%,进阶率为7.1%。发病4-7天内APD组患者病死率为3.58%,进阶率为32.14%。非APD组患者预后情况病死率为17.86%,进阶率为35.71%。发病0-3天内APD组患者器官功能障碍情况好于其他组(P<0.05)。另外入院一周后发病0-3天内APD组与其他两组比较中,显示WBC、CRP、PCT、IL-6、TNF-α降低明显优于其他组(P<0.05),且0-3天APD组住院时间更短,住院费用更低(P<0.05)。结论对于明显伴有腹腔积液的MSAP患者,早期最佳的APD时间窗为发病0-3天内,可明显改善MSAP患者的预后,降低炎症水平,提高生存率,加速患者康复。更多还原

【Abstract】 Objective To explore the effects of different abdominal puncture drainage timing on c-reactive protein(CRP),Procalcitionin(PCT),White Blood cell(WBC),Interleukin6(IL-6),Tumor necrosis factor α(TNF-α)and other laboratory indicators,hospitalization days,hospitalization costs,mortality,advanced rate,organ failure and other clinical indicators in patients with Moderate severe pancreatitis(MSAP)and ascites,Select the best APD time for MSAP patients with ascites.Methods A total of 84 MSAP patients hospitalized in Anqing Hospital affiliated to Anhui Medical University from September 2019 to May 2021 were collected.Twenty-eight patients(12 males and 16 females)were treated with APD within 0-3 days of admission.The average age was(56.32±13.31)years.Twenty-eight patients(13 males and 15 females)were treated with APD within 4-7 days after admission.The average age was(56.46±12.16)years.The remaining 28 patients were treated with non-puncture conservative treatment at admission,including 12 males and16 females,aged 31-72 years,with an average age of(56.50±13.48)years.There were no significant differences in gender and age between APD group and non-APD group within 0-3 days and APD group within 4-7 days(P<0.05).Clinical data were collected on the extraction/admission of patients after puncture,1days,7 days,14 days,C-reactive protein,WBC,PCT,IL-6,TNF inflammation index,hospitalization days,hospitalization expenses and mortality,advanced,organ failure,etc.,and statistical tools were used to analyze and compare the differences of various methods.Results The fatality rate was 0% and the progression rate was 7.1% in the APD group within 0-3 days.The fatality rate and progression rate were 3.58% and 32.14% in the APD group within 4-7 days.The prognosis of non-APD group was 17.86% fatality rate and 35.71% progression rate.Organ failure in APD group was better than that in other groups within 0-3 days(P < 0.05).WBC,CRP,PCT,IL-6 and TNF-α decreased significantly in APD group within 0-3 days after one week(P < 0.05),and the hospitalization time and hospitalization cost in APD group within 0-3 days were shorter and lower than those in other groups(P < 0.05).Conclusion For MSAP patients with obvious peritoneal effusion,the best early APD time is 0-3 days,which can significantly improve the prognosis of MSAP patients,reduce the level of inflammation,improve the survival rate and speed up the recovery of patients.更多还原