王嘉悦^1,,
郑秀娟¹,
罗梦梦¹,
陈建交²,
石芳鑫^3,,
1. 浙江大学医学院附属金华医院 妇产科, 浙江 金华 321000
2. 中山大学孙逸仙纪念医院 普外科, 广东 广州 510120
3. 大连医科大学附属第一医院 妇产科, 辽宁 大连 116011

详细信息 作者简介: 王嘉悦(1990-), 女, 主治医师。E-mail: 836797578@qq.com





通讯作者: 石芳鑫, 教授。E-mail: shifangxin@sina.com 中图分类号: R714


摘要:目的探讨妊娠合并重症急性胰腺炎(severe acute pancreatitis in pregnancy, SAPIP)的临床特征、母儿不良结局及防治措施, 为提高诊疗技术水平及降低母儿不良结局的发生提供参考依据。方法回顾性分析2001年1月1日至2020年12月31日大连医科大学附属第一医院收治的21例妊娠合并SAPIP患者临床资料, 包括年龄、孕周、孕产次、发病时间、病因、临床表现、实验室指标、影像学检查、诊断、治疗、妊娠结局、胎儿结局等。根据孕妇是否发生多器官功能障碍分组, 比较孕妇并发多器官功能障碍综合征及未并发多器官功能障碍综合征组间各临床指标的差异。根据是否发生死胎分组, 比较胎儿死亡组与胎儿存活组间临床资料的差异。结果21例SAPIP患者均出现重症胰腺炎相关临床表现, 影像学检查均提示胰腺炎。其中9例有高脂饮食史, 入院初行腹部B超检查的16例患者中有14例表现为胆石症并发急性胰腺炎, 21例患者入院后的实验室检查结果中血清甘油三酯平均水平(12.87±7.15)mmol/L, 符合高脂血症诊断标准。21例SAPIP患者中10例发生多器官功能障碍综合征。并发多器官功能障碍综合征组白细胞总数、代谢性酸中毒及高脂血症发生率明显高于未并发多器官功能障碍综合征组, 差异有统计学意义(P＜0.05);并发多器官功能障碍综合征组血钙浓度明显低于未并发多器官功能障碍综合征组, 差异有统计学意义(P＜0.05)。除去人工流产2例, 19例患者中3例胎死宫内, 16例胎儿存活。胎儿死亡组多器官功能障碍综合征、失代偿性代谢性酸中毒发生率、白细胞总数, 明显高于胎儿存活组, 差异有统计学意义(P＜0.05);血钙浓度、动脉血气碱剩余, 明显低于胎儿存活组, 差异有统计学意义(P＜0.05)。结论高脂血症及胆道系统疾病是SAPIP的主要诱发因素, 临床指标中血钙浓度降低、白细胞总数升高及代谢性酸中毒提示发生多器官功能障碍综合征及死胎的风险增加。
关键词: 重症急性胰腺炎/
妊娠并发症/
高脂血症/
围产期


Abstract:ObjectiveTo investigate clinical features of pregnant patients with severe acute pancreatitis and to provide effective integrated control strategy.MethodsA retrospective study was performed on the clinical data of 21 pregnant patients with severe acute pancreatitis who were admitted to the hospital from January 1, 2001 to December 31, 2020. According to the occurrence of organ dysfunction, the patients were divided into two groups: group with multiple organ dysfunction syndrome and group without multiple organ dysfunction syndrome; according to the outcome of pregnancy, the patients were divided into stillbirth group and fetal survival group. The clinical data, including age, gestational age, clinical manifestations, laboratory findings, imaging examination, pregnancy outcome and fetal outcome, were analyzed.ResultsThe 21 patients presented with clinical symptoms of severe pancreatitis, and imaging studies confirmed the diagnosis severe acute pancreatitis in pregnancy (SAPIP). Among them, 9 patients had a history of high-fat diet, 14 patients were diagnosed with cholelithiasis. The average serum triglyceride level (12.87±7.15)mmol/L of 21 patients met the diagnostic criteria for hyperlipidemia. All 21 patients showed significant increase in pancreatin level. High serum pancreatin levels hold predictive potential for the diagnosis of SAPIP. Statistically significant indicators for adverse outcomes include decreased blood calcium concentration, increased white blood cell count, and metabolic acidosis.ConclusionsHyperlipidemia and biliary diseases are predisposing factors for severe acute pancreatitis in pregnancy. The decrease in blood calcium concentration, the increase in the total number of white blood cells, and metabolic acidosis indicate an increased risk of multiple organ dysfunction syndrome or stillbirth.
Keywords:severe acute pancreatitis/
pregnancy complications/
hyperlipidemia/
perinatal period

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