Clinical Study On The Pancreatic Function State In Critically Ill Children

Background and Objective: To observe the changes of relevant indicators ofpancreatic exocrine and endocrine, to study the significance of amylase, blood glucose,insulin, C peptide in the progress of the disease, and investigate the relationship betweenclinical features, pancreatic pathological changes and pancreatic damage.Methods:1868critically ill children admitted in pediatric intensive care unit(PICU) ofHunan Children’s Hospital from Apr,2011to Jan,2013were reviewed and analyzedexcluded the children admitted to hospital due to acute pancreatitis, benign and malignantpancreatic disease, diabetes, acute mumps.All the children were given the PCIS scoreswithin24h after admission, In accordance with the contemplated the clinical registrationform to collect information to take the prospective observational and analysis, SAMY, SLP,UAMY, BS, CP, INS were measured and recorded, the children in death group were givenpathological examination of the pancreas and pancreatic tissue damage pathological score.Results:1.The incidences of increased serum amylase and lipase in critically ill children were19.59%,13.60%.The incidence of more than3times higher than the upper limit of normalamylase in hyperamylasemia children was30.05%, SAMY and UAMY were increasedwithin24h after admission, then presented a downward trend on day3and closed to thenormal level on day7, but SLP was normal on day1,3,7.2.The incidences of abnormal BS, CP and INS in critically ill children were44.65%,47.48%and47.43%respectively.In the hyperamylasemia children, the incidence ofhyperglycemia was57.14%, the BS peak was seen within24h after admission, and closedto the normal level on day7.The CP abnormal rate was62.02%(increased accounted for29.23%, reduced accounted for32.78%),The INS abnormal rate was62.30%(increased accounted for33.06%, reduced accounted for29.23%), CP and INS gradually returned tonormal levels on day7.3.According to the analysis, stress ulcer, convulsions, coagulation disorders, incidences ofdisturbance of consciousness, sepsis, shock, MODS in SAMY elevated3times group weresignificantly higher than the control group.and incidences of shock and MODS were higherthan mildly elevated group (P <0.05), fever, vomiting, diarrhea, abdominal tenderness,ascites, peritoneal irritation, decreased bowel sounds had no difference among the threegroups. WBC, PCT and CRP in SAMY elevated3times group were significantly higherthan mildly elevated group and control group, serum calcium levels was lower than mildlyelevated group and the control group (P <0.05). HCT was within the normal range, lacticacid, BE negative, LDH, Alt, AST, CK-MB were higher than mildly elevated group and thecontrol group (P <0.05).4.The incidence of PCIS≤80increased with the elevated SAMY levels. PCIS in SAMYcontrol group, mildly elevated group increased3times the average were85.16±8.14,80.31±6.51,77.35±12.54points, had statistically significant difference among the threegroups. PCIS scores was more lower in high amylase hyperglycemia group, and number oforgan failure, and higher mortality were increased.5.WBC, CRP, lactate, BE negative, LDH in the high amylase combined hyperglycemiagroup were higher than that the control group (P <0.05), serum calcium was lower than thecontrol group (P <0.05), HOMA-beta index and high amylase combined hyperglycemiawere closely related.6.The results of pancreatic B-ultra showed that only38cases (10.38%) had abnormalpancreatic ultra, included hemorrhage, edema, pancreatic duct dilatation. Cases of pancreasthickness increased in mildly elevated group and increased3times group were higher thanthe control group(P <0.05).. Cases of pancreas thickness increased in high amylasecombined hyperglycemia group was higher than high amylase group and control group(P<0.05)..7.The death group(151cases), of which122cases were given pancreatic pathological examination, varying degrees of damage, including pancreatic edema, hemorrhage,inflammatory cell infiltration and necrosis in71cases. pancreas histopathological scores inAbnormal Trypsin group was higher than the control group, and that in the high amylasecombined hyperglycemia group were higher than high amylase group and control group(P<0.05).Conclusion: The changes of relevant indicators of pancreatic exocrine and endocrinewere significantly correlated with the characteristics of the disease and pancreaticpathology in critically ill children with pancreatic function status changes and pancreasdamage. High serum amylase and high blood glucose were closely related to pancreaticdamage, which can be used as a clinical necessary early warning indicators of pancreaticdamage in critically ill children.