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本文分析我院过去16年间连续收治的重症急性胰腺炎70例及其中并发MOF者17例,以探讨影响重症胰腺炎临床治愈率的限制性因素。本组总病死率为20.0％,其中12例死亡与MOF有关,占85.7％;MOF的病死率高达70.6％。于胰腺炎病程不同时期发生的MOF具有不同的临床过程或模式,可分为早期速发单相型和后期迟发双相型。与重症胰腺炎后MOF有关的发病因素包括早期循环休克、胰腺脓毒症及重度胰坏死等,后者可能是MOF发病中的主导因素。重症胰腺炎后MOF的临床过程以显著的全身炎性反应为特征,由局部胰腺毒性病灶始动的失控的全身炎性反应可能是重症胰腺炎导致MOF的共同病理通路。
This article analyzes the hospital over the past 16 consecutive years of severe acute pancreatitis in 70 cases and 17 cases of complicated with MOF in order to explore the impact of severe pancreatitis clinical cure rate limiting factors. The total case fatality rate of 20.0%, of which 12 cases of death and MOF, accounting for 85.7%; MOF mortality rate as high as 70.6%. MOFs occurring at different stages of the course of pancreatitis have different clinical processes or modes and can be divided into early rapid onset monophase and late late onset biphasic. The morbidity factors associated with MOF after severe pancreatitis include early circulatory shock, pancreatic sepsis and severe pancreatic necrosis, which may be the predominant factor in the pathogenesis of MOF. The clinical course of MOF after severe pancreatitis is characterized by a marked systemic inflammatory response, and the uncontrolled systemic inflammatory response initiated by local pancreatic toxic lesions may be the common pathological pathway leading to MOF in severe pancreatitis.