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One Postoperative Patient with Severe Acute Pancreatitis Complicated with Persistent Hypotension
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摘要: 探讨重症急性胰腺炎(severe acute pancreatitis, SAP)术后患者出现持续性低血压的诊断思路及治疗方式。通过回顾性分析1例SAP术后出现持续性低血压患者的临床资料，总结其诊断思路及治疗策略。患者男性，61岁，SAP术后转入重症医学科，起初表现为低血容量性休克且伴发感染，经容量复苏及抗感染治疗后症状得以控制，但仍以持续性低血压为主要表现，经对各类型休克逐一鉴别、激素测定后确诊为重症相关肾上腺皮质功能不全，使用激素替代治疗后患者低血压症状得到改善，遂转出。1个月后随访，患者停用激素，血压恢复正常。故SAP术后患者、感染症状控制后出现难以解释的低血压，需考虑合并重症相关肾上腺皮质功能不全的可能，早期诊断及激素替代治疗有助于患者康复。Abstract: The aim of this article was to explore the diagnostic approach and treatment of persistent hypotension in postoperative patients with severe acute pancreatitis(SAP). The diagnostic approach and treatment were summarized through retrospectively analyzing the clinical data of one SAP patient with persistent postoperative hypotension. This was a 61 years old male SAP patient and was transferred to the department of critical care medicine after surgery. Hypovolemic shock and infection, the initial features of this patient, were controlled after resuscitation and anti-infective therapy. But the patient still had persistent hypotension. All types of shock were distinguished and hormone examination was performed. The patient was finally diagnosed as critical illness-related corticosteroid insufficiency(CIRCI). The symptom of persistent hypotension was significantly improved after hormone replacement. At the one-month follow-up, the patient's blood pressure returned to normal and then hormone therapy was stopped. The possibility of CIRCI should be taken into account when a SAP patient with unexplained persistent postoperative hypotension after the successful control for infection. Early diagnosis and glucocorticoid replacement therapy is helpful for the recovery of the patients.
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Key words:
- severe acute pancreatitis /
- adrenal insufficiency /
- surgery /
- hypotension /
- glucocorticoid
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表 1 本例患者术后肾上腺皮质功能测定
项目 术后第1天 术后第7天 T0 T30min T60min ACTH(pg/ml) 10.34 11.14 - - PTC(μg/dl) 15.36 11.30 16.56 15.42 ACTH：促肾上腺皮质激素；PTC：皮质醇 
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