| Objective: To analyze the clinical features of acute pancreatitis (AP) in elderly patients.Methods: The AP patients from May 2008 to December 2010 in the first affiliated hospital of Dalian Medical University were studied retrospectively. 210 cases were allocated to two groups: aged group (≥60y) had 90 cases and non-aged group (<60y) had 120 cases. The data included sex, age, hospitalization days, etiological factors, clinical manifestations, the results of S-AMY, S-LIP, WBC, blood glucose, blood calculus, blood fat, liver and kidney functions. The consequences of B-ultrasonic or CT/MRI about superior belly were recorded too. Meanwhile, the complications, therapeutic schedule and the turnover of AP also had been analyzed.Results:1.Comparison in general dataThe mean age in elderly group was 70.90±8.08y, and the eldest was 90y, while the mean age was 39.26±11.21y in the non-aged group, and the youngest was only 16y. The sex ratio was different: Male vs female was 1:1.38 in aged group and 1.61:1 in non-aged group. The differences between two groups were statistically significant (P<0.05). The average hospitalization days of the two groups were 12.02±0.56d and 9.81±0.52d, which indicated that the aged group stayed significantly longer than the non-aged group in hospital (P<0.05). The elderly group was diagnosed in 90 cases for 111 times, which recurrence rate was 17.8%, and 120 cases for 156 times in non-aged group, which recurrence rate was 15.8%. It didn`t have significantly difference between the two groups (P>0.05). 2.Comparison in etiological factorThe causes of AP in elderly group were biliary tract disease (48.9%), no exact factors (27.8%), binge overeating (12.2%) and heavy drinking (11.1%); but the causes in non-aged group were biliary tract disease (35.8%), heavy drinking (30.8%), binge overeating (23.3%) and no exact factors (10.0%). The principal reason of the two groups were both biliary tract factors (P>0.05). Secondary, the reason of the elderly group was no exact factors, while heavy drinking in non-aged group. The third reason of the two groups was both binge overeating. The differences between two groups for the second and third reason were statistically significant (P<0.05).3.Comparison in clinical manifestationThe incidence of typical symptoms (upper abdominal pain, nausea, vomiting) and peritoneal irritation sign in aged group were markedly less than those in non-aged group (P<0.05). But the untypical symptoms as abdominal distension and jaundice were significantly more in the aged group (P<0.05).4.Comparison in the laboratory examinationThe average time when the AP patients went to our hospital was 51.35±13.42 hours. The positive rates of S-AMY which step-up three times higher than the normal range were assayed 80.0% and 70.8% in the two groups. We also assayed the two groups` S-LIP level, which step-up two times higher than the normal range and its positive rates were 94.1% and 90.5% (P>0.05). The assayed positive rates of S-LIP were significantly higher than that of S-AMY`s (P<0.05). In addition, it was significantly easier to happen some abnormal conditions in elderly group, such as the WBC increased, hyperglycosemia, hypocalcemia, dysfunction of liver and renal (P<0.05).5.Comparison in imaging detectionThe diagnosis rate about B-ultrasonic (58.4%) in elderly was significantly lower than that in non-aged group (72.5%)(P<0.05). The CT/MRI diagnosis rates in the two group were 75.3% and 76.7% (P>0.05), which was slightly higher in both groups (P>0.05).6.Comparison in clinical typing and complicationsThe incidence of severe acute pancreatitis (23.3%) in elderly were significantly higher than that of the non-aged group (10.8%) (P<0.05). The complications in the elderly group, for example, pneumonia, pleural effusion, arrhythmia, renal insufficiency, intestinal obstruction, etc. were obviously more than those of the non-aged group. Aged patients with chronic illness, such as hypertension, diabetes, coronary heart disease, stroke, etc. were significantly more than the non-age ones, while the rate of the nutrition metabolic disease as hyperlipidemia and fatty liver were obviously lower than the non-age group(P<0.05).7.Comparison in therapy methodAll patients in hospital were treated by internal comprehensive methods, and 182 cases (86.7%) had achieved a good curative effect by conservative treatment. The proportions of fasting water, gastrointestinal decompression, PPI acid agents suppression and antibiotic were used significantly more in aged patients (P<0.05). Moreover, 57 cases in aged group and 68 cases in non-aged group used somatostatin and enzyme inhibitors. There were 12 cases in aged group and 9 cases in non-aged group cured by the endoscopic means (ERCP+EST+ENBD) (P>0.05).8.Comparison in AP turnoverThe cure rate (68.9%) of the elderly was lower than that of the non-aged group (80.8%)(P<0.05), and the mortality (12.2%) was significantly higher in the elderly group (0.8%) (P<0.01).Conclusions:1.There were more women than men in elderly patients with AP, whose clinical manifestation and peritoneal irritation sign were not typical. The rate of MAP was also significantly higher.2.The etiological factors of acute pancreatitis in elderly were different from the non-aged ones. Biliary tract disease and no exact factors were the main reasons for the elderly AP patients.3.It had been proofed that non-operative treatment was still the main therapy method for elderly AP patients. |
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