重症急性胰腺炎合并胰性脑病30例分析

摘要

目的 探讨重症急性胰腺炎合并胰性脑病的临床特点、出现时间与血尿淀粉酶、脑脊液、脑电图以及颅脑CT变化的关系.方法 根据1992年亚特兰大国际胰腺病会议制定"急性重症胰腺炎"的定义和中华消化学会胰腺病学组2003年上海会议制定的"急性胰腺炎诊治指南"作为诊断标准,并排除Wernicke脑病后进行回顾分析.结果 30例胰性脑病中,合并消化道出血16例,胸腹水14例,ARDS 3例,感染性休克2例,低钙血症10例,胰周脓肿2例,中毒性心肌炎9例,并发症发生率占86.3%;始发病因以胆源性疾患居多,出现精神神经症状的中位时间为8 d;PE组72 h BA、PEBA水平和各种并发症的发生率与对照组差异有显著性(P＜0.05).结论 胰性脑病发病高峰期多为病发后1周内,常与其他并发症并存;病人症状为反应迟钝、定向力障碍、意识模糊、幻觉及昏迷等;但脑脊液、脑电图及颅脑CT均正常;血中淀粉酶增高是PE发生的关键环节,其它并发症是促发因素;及时采用药物控制PLA2的释放及胰腺实质的广泛坏死,对于提高重症急性胰腺炎的抢救成功率,减轻胰性脑病发生,降低死亡率很有意义.%Objective To investigate the relationship between clinical characteristic arising period of severe acute pancreatitis with pancreatic encephalopathy and changes in blood and uric amylase,CSF and CT.Methods Retrospective analysis was conducted according to diagnostic standard of pancreatic encephalopathy proclaimed by the International Pancreatitis Meeting in Atlanta(1992).Results Amongst the 30 cases with pancreatic encephalopathy,16 had hemorrhage in alimentary tract and 14ascites.Three cases had ARDS,2 had infective shock and 10 had calcium deficiency in blood.Conclusion The fastigium of pancreatic encephalopathy often appears together with the various syndromes in the first week.The common symptoms of PE are reaction retardation,fixed-point representation,abnormal delusion and hallucination,coma etc.But the findings in CSF,CT and electroencephalograhy are normal.