| Part One:Clinical characteristics of 486 acute pancreatitisObjective To analysis and research of clinical feathers of acute pancreatitis to improve the understanding,diagnosis and treatment of this disease,and provide the reference foundation for future clinical workings.Methods The clinical data collected from the First Affiliated Hospital of Soochow University of 486 patients with acute pancreatitis during January 2015 to October 2017 were retrospectively analyzed,including general conditions,etiology,relapse,clinical feature,auxiliary examination,complications,treatment and prognosis.Results(1)In 486 patients with AP,the ratio of males and females was 1.18:1,the average age of AP was(53.51±17.15),among which the incidence of female was higher than that of male,and the difference was statistically significant(t=3.520,P=0.001).There were 326 cases(67.1%)of patients with acute pancreatitis,and 101 cases(20.8%)of patients with moderate severe acute pancreatitis,and 59 cases(12.1%)of patients with severe acute pancreatitis.(2)Biliary is the most common cause(50.2%),followed by hyperlipidemia and alcohol,81 cases(16.7%)and 54 cases(11.1%),Among them,biliary disease is more common in women,and alcoholic diseases are more common in men,both of which have statistical differences(P < 0.01).The average age of the patients with biliary venerosis was the highest in the group,and the average age of the patients in the hyperlipidemia group was the lowest,(59.16 ± 17.12)and(41.46 ± 9.85).(3)All patients had abdominal pain,which was characterized by severe pain or colic(57.2%)in the middle and upper abdomen(76.3%),with nausea and vomiting(50.2%).The serum amylase value of 72.2% patients increased by three times and above.The detection rate of AP was 96.1%,and the detection rate of b-ultrasound was 78.2%.(4)The most common local complication of AP was acute fluid accumulation(86.7%),and the most common systemic complication was acute respiratory distress syndrome(29.8%).Among all AP patients,372 cases(76.5%)were cured,89 cases were improved(18.3%),10 patients were discharged from hospital(2.1%),and 15 cases were dead(3.1%).(5)There were 142 cases(29.2%)of recurrent acute pancreatitis,of which biliary venereal disease was the most common etiology(38.7%).Conclusion AP was more common in middle-aged and old people,and the onset age of women was older than men.The most common etiology was biliary,followed by hyperlipidemia and alcohol.Abdominal pain is the most common clinical manifestation.The early diagnostic detection rate of CT for AP is higher than that of b-ultrasound.The most common complication of AP is the accumulation of acute fluid,and organ failure is more common in lung,and the total mortality rate of AP is 3.1%.Part Two:The clinical significance of acute pancreatitis classification based on the new classification standard of AtlantaObjective To research and analysis of MAP,MSAP and SAP under the new classification standard of Atlanta to verify the guiding significance for the clinical treatment and the prognosis of the disease.Methods 486 cases of patients collected from the First Affiliated Hospital of Soochow University with acute pancreatitis,according to the Atlanta new classification standards,weredivided into MAP,MSAP and SAP group with retrospectively analysisResults(1)In 486 cases of patients with acute pancreatitis,there were 326 cases(67.1%)of mild acute pancreatitis;101 cases(20.8%)of moderately severe acute pancreatitis,59 cases(12.1%)of severe acute pancreatitis.No obvious difference was found between different sex ratio in the three groups(?2=1.51,P=0.472).The average age of onset of moderate severe acute pancreatitis(60.38 ± 16.72)was higher than that of mild acute pancreatitis and severe acute pancreatitis,with statistical significance(F=11.49,P < 0.01).(2)The main pathogeny of MAP and MSAP patients was biliary,and hyperlipidemia was the first(44.1%)in SAP patients.(3)Compared with MAP and MSAP,the white blood cells,blood glucose and triglycerides of SAP patients increased,and blood calcium decreased(P < 0.01).(4)The average length of hospitalization in SAP was(18.90±11.37)days,significantly higher than that of MAP and MSAP(P < 0.01).Systemic complications of MSAP were often seen in acute respiratory distress syndrome(53.8%,7/13).SAP mortality rate was 25.4%(15 / 59),the death of patients with organ failure mainly in lung(26.7%,4/ 15)and kidney(20%,3/15).(5)There were 99 cases of recurrent acute pancreatitis(69.7%),19 cases(13.4%)in MSAP,24(16.9%)in SAP,and the incidence of SAP in recurrence group was significantly higher than that in the initial group(P=0.039).Conclusion Leukocyte,blood glucose,triglyceride,serum calcium were related to the severity of AP.Hospitalization time of SAP were significantly longer than that of MAP and MSAP.All dead patients were SAP,the mortality rate was 25.4%.SAP patients mainly died of acute respiratory distress syndrome and acute renal injury.The classification of AP under the new classification of Atlanta has a guiding significance for clinical treatment and prediction of the prognosis of the disease. |
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