吴本华　周应生　雷平光

[摘要] 目的 探讨猪尾巴管腹腔灌洗治疗急性重症胰腺炎介入时机的选择。 方法 采用回顾性队列研究方法，选择2014年3月～2016年10月我院收治60例重症急性胰腺炎患者作为研究对象，在一般保守治疗的基础上，加用猪尾巴管腹腔灌洗治疗，根据介入时机（24h内、48h内、72h内）分为A、B、C组，每组20例；根据B超检查是否可见腹腔积液分为D组和E组；以C反应蛋白（CRP）值、APACHE II值、中性粒细胞计数（NEU）、全身炎症反应综合征（SIRS）持续时间、加用连续肾脏替代疗法（CRRT）例数和死亡例数作为观察指标。 结果 A、B、C组治疗前CRP值、APACHE II值、NEU比较差异无统计学意义（P>0.05）；治疗第7天，A、B、C组CRP值、APACHE II值、NEU均较治疗前下降，差异有统计学意义（P<0.01），且组间比较差异有统计学意义（P<0.05）；随着猪尾巴管腹腔灌洗治疗时间的延迟，CRP值、APACHE II值、NEU下降程度随之减小，差异有统计学意义（P<0.05）；A、B、C组无死亡病例，SIRS持续时间、加用CRRT例数比较差异有统计学意义（P<0.05）；D组经B超检查可见腹腔积液，共35例；E组经B超检查未见腹腔积液，共25例；D组与E组治疗前腹腔内压比较差异有统计学意义（P<0.05）；D組与E组治疗第7d，腹腔内压均较治疗前下降，差异有统计学意义（P<0.01），且组间比较差异有统计学意义（P<0.05）。 结论 不同的猪尾巴管腹腔灌洗介入时机在急性重症胰腺炎治疗中的效果不同，若经B超检查可见腹腔积液，在24小时内加用猪尾巴管腹腔灌洗治疗作为最佳的介入时机。

[关键词] 急性重症胰腺炎；腹腔灌洗；介入时机

[中图分类号] R576 [文献标识码] A [文章编号] 2095-0616（2017）15-154-05

[Abstract] Objective To explore the time of interventional therapy for acute severe pancreatitis with peritoneal lavage with pigtail tube. Methods Retrospective cohort study method was used.60 patients with severe acute pancreatitis cured in our hospital grom March 2014 to October 2016 were selected as the study object.On the basis of general conservative treatment，the pig tail tube was used for abdominal lavage.They were divided into group A，group B and group C，according to the timing of intervention（24h，48h，72h），with 20 patients in each group.According to B ultrasonic examination，peritoneal effusion was divided into group D and group E.The C reactive protein（CRP），APACHE，II，neutrophil count（NEU），systemic inflammatory response syndrome（SIRS）duration，and the number of consecutive renal replacement therapy（CRRT）cases and deaths were used as observation indicators. Results There were no statistical significance on CRP value，APACHE，II value，and NEU between the three groups.On the 7d after treatment，the CRP value，APACHE，II value，NEU of group A，group B and group C were lower than before treatment，there were significant differences（P<0.01），and there were differences between groups（P<0.05）.With the delay of peritoneal lavage treatment，the decrease of CRP，APACHE，II and NEU decreased（P<0.05）.There were no deaths in group A，group B and group C.The duration of SIRS and the number of CRRT cases were compared（P<0.05）.In group D，ascites was detected by ultrasonography，and there were 35 cases.The E group had no peritoneal effusion after B ultrasonic examination，and there were 25 cases.There were differences in the intra abdominal pressure before and after treatment in group D and group E（P<0.05）.In group D and group E，on the 7D after treatment，intraperitoneal pressure decreased significantly，compared with before treatment （P<0.01），and there were differences between groups（P<0.05）. Conclusion Different pig tail tubes，peritoneal lavage，interventional timing in the treatment of severe acute pancreatitis have different effects.If the ultrasound examination shows peritoneal effusion，within 24 hours of the tube peritoneal lavage therapy is the best time to intervene with pig tail.

[Key words] Severe acute pancreatitis；Peritoneal lavage；Intervening time

急性重症胰腺炎作为临床较为常见的急腹症之一，具有起病突然、病情严重、进展迅速、并發症发生多、病死率高等特点[1]。在临床上，急性重症胰腺炎的发生、发展与胰腺组织坏死密切相关，释放大量的炎性介质、毒性产物，并被腹膜吸收，触发全身炎症反应综合征（SIRS），若早期采取外科手术治疗，风险较大，甚至因发生并发症而恶化病情。近年来，在B超引导下，采取猪尾巴管腹腔灌洗急性重症胰腺炎已取得较大进展，可以有效减少并发症发生，降低死亡率。另外，相当一部分急性重症胰腺炎患者合并腹腔积液，需经B超检查，及时采取猪尾巴管腹腔灌洗治疗极其重要；但关于猪尾巴管腹腔灌洗治疗急性重症胰腺炎介入时机的研究较少，尚未形成统一结论[2-3]。对……