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重症急性胰腺炎术后并发持续性低血压一例

杨婧 陈瑶 康焰

杨婧, 陈瑶, 康焰. 重症急性胰腺炎术后并发持续性低血压一例[J]. 协和医学杂志, 2018, 9(5): 463-366. doi: 10.3969/j.issn.1674-9081.2018.05.017
引用本文: 杨婧, 陈瑶, 康焰. 重症急性胰腺炎术后并发持续性低血压一例[J]. 协和医学杂志, 2018, 9(5): 463-366. doi: 10.3969/j.issn.1674-9081.2018.05.017
Jing YANG, Yao CHEN, Yan KANG. One Postoperative Patient with Severe Acute Pancreatitis Complicated with Persistent Hypotension[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 463-366. doi: 10.3969/j.issn.1674-9081.2018.05.017
Citation: Jing YANG, Yao CHEN, Yan KANG. One Postoperative Patient with Severe Acute Pancreatitis Complicated with Persistent Hypotension[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 463-366. doi: 10.3969/j.issn.1674-9081.2018.05.017

重症急性胰腺炎术后并发持续性低血压一例

doi: 10.3969/j.issn.1674-9081.2018.05.017
基金项目: 

国家青年自然科学基金 81701880

详细信息
    通讯作者:

    康焰  电话:028-85422739,E-mail:kangyan@scu.edu.cn

  • 中图分类号: R576;R441.9

One Postoperative Patient with Severe Acute Pancreatitis Complicated with Persistent Hypotension

More Information
  • 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。
  • 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
    下载: 导出CSV
  • [1] Buter A, Imrie CW, Carter CR, et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis[J]. Br J Surg, 2002, 89: 298-302. doi:  10.1046/j.0007-1323.2001.02025.x
    [2] Halonen KI, Pettilä V, Leppäniemi AK, et al. Multiple organ dysfunction associated with severe acute pancreatitis[J]. Crit Care Med, 2002, 30: 1274-1279. doi:  10.1097/00003246-200206000-00019
    [3] Majidi S, Golembioski A, Wilson SL, et al. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment[J]. South Med J, 2017, 110: 727-732. doi:  10.14423/SMJ.0000000000000727
    [4] Uhl W, Warshaw A, Imrie C, et al. LAP Guidelines for the Surgical Management of Acute Pancreatitis[J]. Pancreatology, 2002, 2: 565-573. doi:  10.1159/000067684
    [5] Singer M, Deutschman CS, Seymour CW, et al. The third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016, 315:801-810. doi:  10.1001/jama.2016.0287
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    [7] Pastores SM, Annane D, Rochwerg B, et al. Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ⅲ Patients (Part Ⅱ): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017[J]. Crit Care Med, 2018, 46:146-148.
    [8] Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab, 2016, 101:3888-3921. doi:  10.1210/jc.2016-2118
    [9] Yanase T, Tajima T, Katabami T, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline[J]. Endocr J, 2016, 63:765-784. doi:  10.1507/endocrj.EJ16-0242
    [10] Gibbison B, López-López JA, Higgins JP, et al. Corticos-teroids in septic shock: a systematic review and network meta-analysis[J]. Crit Care, 2017, 21:78. doi:  10.1186/s13054-017-1659-4
    [11] Annane D, Bellissant E, Bollaert PE, et al. Corticos-teroids in the treatment of severe sepsis and septic shock in adults: a systematic review[J]. JAMA, 2009, 301:2362-2375. doi:  10.1001/jama.2009.815
    [12] Annane D, Renault A, Brun-Buisson C, et al. Hydro-cortisone plus Fludrocortisone for Adults with Septic Shock[J]. N Engl J Med, 2018, 378:809-818. doi:  10.1056/NEJMoa1705716
    [13] Bhatia M, Wong FL, Cao Y, et al. Pathophysiology of acute pancreatitis[J]. Pancreatology, 2005, 5:132-144. doi:  10.1159/000085265
    [14] Arlt W, Hammer F, Sanning P, et al. Dissociation of serum dehydroepiandrosterone and dehydroepiandrosterone sulfate in septic shock[J]. J Clin Endocrinol Metab, 2006, 91:2548-2554. doi:  10.1210/jc.2005-2258
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出版历程
  • 收稿日期:  2018-07-04
  • 刊出日期:  2018-09-30

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