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ObjectiveTo investigate the clinical features and maternal and fetal outcomes of acute pancreatitis in pregnancy （APIP） and the risk factors for disease aggravation， and to establish a predictive model. MethodsA retrospective analysis was performed for 52 APIP patients who were admitted to Affiliated Hospital of Zunyi Medical University from January 2017 to December 2022， and according to disease severity， they were divided into mild acute pancreatitis （MAP） group with 32 patients， moderate-severe acute pancreatitis （MSAP） group with 8 patients， and severe acute pancreatitis （SAP） group with 12 patients. The logistic regression analysis was performed for the clinical data of each group，and the receiver operating characteristic （ROC） curves were plotted to assess the value of risk factors in predicting the severity of APIP. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups，and the least significant difference t-test was used for further comparision between two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups，and the Wilcoxon rank-sum test was used for further comparision between two groups； the chi-square test was used for comparison of categorical data between groups. ResultsOf all patients in terms of etiology， 26 （50%） had hyperlipidemic pancreatitis， 20 （38.4%） had biliary pancreatitis， and 6 （11.5%） had idiopathic pancreatitis. In terms of gestational week， 1 patient （1.9%） was in early pregnancy， 25 （48.1%） were in mid-pregnancy， and 26 （50.0%） were in late pregnancy. A total of 10 patients （19.2%） had acute respiratory distress syndrome （ARDS）， among whom 9 （90%） required respiratory support. There were significant differences between the patients with different severities of APIP in aspartate aminotransferase， alanine aminotransferase， blood urea nitrogen， blood glucose， C-reactive protein （CRP）， international normalized ratio （INR）， pneumonia， ARDS， sepsis， hepatic insufficiency， and coagulation dysfunction （all P<0.05）. The univariate analysis showed that the severity of APIP was associated with blood glucose， blood urea nitrogen， CRP， and pneumonia （all P<0.05）， and pneumonia was a risk factor for the aggravation of APIP （odds ratio=18.938， 95% confidence interval： 1.020 — 351.747， P=0.048）. CRP， blood glucose， blood urea nitrogen， and INR used in combination had a larger area under the ROC curve than each index used alone （0.954 vs 0.778/0.796/0.721/0.801）. ConclusionPneumonia is a risk factor for the aggravation of APIP， and the combination of CRP， blood glucose， blood urea nitrogen， and INR can be used to predict the severity of APIP.
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Objective:To evaluate the superior effect of thoracic epidural block (TEB) used for analgesia in patients with severe acute pancreatitis (SAP).Methods:Fifty patients of both sexes, aged 18-64 yr, with SAP, with Japanese severity score (JSS) ≥3, onset time of SAP≤12 h, were divided into conventional analgesia group (group C) and TEB group.Sufentanil was intravenously infused for analgesia in group C. TEB was performed for analgesia in group TEB.In group C, sufentanil was intravenously infused at a rate of 0.2-0.3 μg·kg -1·h -1 after admission to hospital.In group TEB, an epidural catheter was placed at T 9, 10 interspace, and 0.66% lidocaine mixed with 0.33% ropivacaine was epidurally infused at a rate of 3-5 ml/h for 120 h after admission to hospital.Visual analog scale (VAS) score and intra-abdominal pressure (IAP) were recorded at 1, 24, 48, 72 and 120 h of analgesia.HR, respiratory rate (RR), oxygenation index, computed tomography severity index (CTSI), JSS and Ranson scores were recorded at 24, 72 and 120 h of analgesia, and the de-criticalization within 72 h following analgesia was evaluated. Results:Compared with group C, VAS score and IAP were significantly deceased at each time point ( P<0.05), the rate of de-criticalization (60%/90%) was increased ( P<0.05), and Ranson score, CTSI score and JSS score were decreased at 120 h of analgesia in group TEB ( P<0.05). Conclusion:TEB can not only produce good analgesic effect, but also improve the development of the disease, which has superior effect compared with routine analgesia when used for the treatment of SAP.