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为了解左旋门冬酰胺酶 (L Asp)诱发儿童急性胰腺炎的临床特点 ,以利早期诊断和治疗 ,对我院 1 996年以来 5年间在应用有L Asp的化疗方案治疗 6 75例次时 ,发生急性胰腺炎 1 9例的临床特点、血液学和影象学检查及治疗预后作了总结分析。结果显示 ,L Asp诱发急性胰腺炎的发生率为 2 81 % ,多在初次诱导治疗用L Asp的期间发病。 1 9例临床表现中 1 7例腹痛 ,同时多伴恶心和呕吐 ;发烧 1 4例、1 3例腹胀 ,1 2例休克。首发症状中主为腹痛 ,次为休克。血液检查中血淀粉酶 1 6 / 1 9例升高 ,高血糖 1 2 / 1 9例、低血钠 1 1 / 1 8例、低血钙 9/ 1 8例、低蛋白 8/ 1 6例、酸中毒 7/ 1 8例及肾功不良 3例。凝血三项 1 0 / 1 6例异常。合并症中有肝损害或者脂肪肝 ;腹膜炎及感染。B超或CT检查 1 6 / 1 8例 ( 88 9% )有异常 ,腹部B超更为敏感。抢救休克和抑制胰酶分泌是最重要的非手术治疗措施 ;出血坏死性胰腺炎病势凶险 ,应及早手术。 1 9例胰腺炎中 1 3例治愈 ,其中 1 1例水肿型痊愈 ;9例出血坏死型中 2例存活 ,7例死于休克。可以结论 ,L Asp诱发急性胰腺炎虽然少见却病死率高 ,尤其是出血坏死型病势凶险。结合L Asp用药史 ,监测病人腹痛或休克表现 ,检测血淀粉酶及腹部B超可以使早期诊断成为可能。抢救休克、?
In order to understand the clinical features of L-aspara-induced acute pancreatitis in children, to facilitate the early diagnosis and treatment of children, our hospital in 1996 5 years in the application of L Asp chemotherapy treatment of 675 cases , 19 cases of acute pancreatitis occurred in clinical features, hematology and imaging studies and treatment prognosis were analyzed. The results showed that the incidence of acute pancreatitis induced by L Asp was 2 81%, mostly during the first induction of L Asp therapy. In the clinical manifestations of 1 9 cases, 17 cases had abdominal pain accompanied by nausea and vomiting; 14 cases had fever, 13 cases had bloating, and 12 cases had shock. The first symptom of the main abdominal pain, times as shock. Blood amylase in the blood test 1 6/1 9 cases of elevated hyperglycemia 1 2/1 9 cases of hyponatremia 1 1/1 8 cases, hypocalcemia 9/1 8 cases, low protein 8/16 cases , Acidosis 7/1 8 cases and 3 cases of renal dysfunction. Coagulation three 1/1 6 abnormal. Complications of liver damage or fatty liver; peritonitis and infection. B ultrasound or CT examination 1 6/1 8 cases (88 9%) have abnormalities, abdominal B-more sensitive. Rescue shock and inhibition of pancreatic enzyme secretion is the most important non-surgical treatment; hemorrhagic necrotizing pancreatitis is dangerous and should be treated as soon as possible. In 13 cases of pancreatitis, 13 cases were cured, of which 11 cases of edema cured; 9 cases of hemorrhagic necrosis in 2 cases survived, 7 died of shock. It can be concluded that, although rare, L Asp-induced acute pancreatitis has a high mortality rate, especially hemorrhagic and necrotic disease. Combination of L Asp medication history, monitoring of patients with abdominal pain or shock performance, detection of blood amylase and abdominal B ultrasound can make early diagnosis possible. Rescue shock ,?