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Pancreatite aguda : casuística dos internamentos na UCIPed do HSM de 2006 a 2014
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Introdução: A pancreatite aguda (PA) é um problema emergente na pediatria, tendo vindo a verificar-se nos últimos anos um aumento da sua incidência. No entanto, os estudos adaptados à idade pediátrica são ainda muito limitados.
Objetivo e Métodos: Fez-se um estudo retrospetivo, com o propósito de realizar uma análise descritiva dos internamentos com o diagnóstico de PA entre 2006 e 2014 na Unidade de Cuidados Intensivos Pediátricos (UCIPed) do Hospital de Santa Maria (HSM). A análise foi feita com recurso a pesquisa dos dados informatizados de cada doente.
Resultados: Entraram na análise 13 crianças, sendo a mediana das idades 13 anos e a duração média dos internamentos 9,6 dias. A etiologia mais frequente foi a medicamentosa (n = 5). A dor abdominal, presente em todas as crianças como forma de manifestação, foi mais frequentemente descrita como generalizada (n = 4). A amilase e a lipase encontravam-se elevadas em 11 e cinco dos casos, respetivamente. O derrame pleural foi a complicação mais frequente e, na avaliação imagiológica, o edema pancreático foi a alteração mais comummente descrita. Nas primeiras 48h, sete das crianças apresentavam critérios para PA grave (critérios de DeBanto et al). A pausa alimentar durou cerca de 2,71 dias. A antibioticoterapia foi iniciada em nove casos. Não se verificaram óbitos.
Conclusão: Atendendo ao contexto do elevado número de internamentos oncológicos, a etiologia medicamentosa foi a mais frequente. Apesar de nas primeiras 24h dez doentes cumprirem critérios de gravidade, não se registou nenhum óbito. O início precoce da fluidoterapia constituiu uma das medidas de suporte implementadas a todos os doentes e a alimentação foi iniciada em todos os casos por via entérica. A antibioticoterapia foi apenas instituída nas crianças em que existia suspeita de infeção.
Background: Acute pancreatitis (AP) is an emerging problem in Pediatrics, which can be established by the increase in occurrences during the last few years. However, studies adapted to the pediatric age group are still very limited. Objective and Methods: A retrospective study was performed to develop a descriptive analysis of the profile of the patients with the AP diagnosis, admitted between 2006 and 2014 in the Pediatric Intensive Care Unit (PICU) of Hospital de Santa Maria (HSM). The analysis was conducted by accessing computerized patient data. Results: Thirteen children met the diagnostic criteria with a median age of 13 years old and a mean hospital stay of 9,6 days. The most frequent etiology was drug use (n = 5). Abdominal pain was present in every child, most frequently being reported as diffuse abdominal pain (n = 4). Amylase and lipase were elevated in 11 and five of the cases, respectively. Pleural effusion was the most frequent complication and pancreatic edema was the most common finding in imaging studies. In the first 48 hours, seven of the children presented with criteria of severe pancreatitis (DeBanto et al score). Bowel rest lasted on average 2,71 days. Antibiotic therapy was started in nine children. There were no deaths reported. Conclusions: Attending to the high number of oncologic patients, drug use was the most frequent etiology. Despite seven patients filling the severity criteria in the first 48h, there were no deaths reported. The early start of fluid therapy constituted one of the support measures which were implemented to all patients and the feeding process was started in all cases by the enteral route. Antibiotic therapy was only started in children with a clinical suspicion of infection.
Background: Acute pancreatitis (AP) is an emerging problem in Pediatrics, which can be established by the increase in occurrences during the last few years. However, studies adapted to the pediatric age group are still very limited. Objective and Methods: A retrospective study was performed to develop a descriptive analysis of the profile of the patients with the AP diagnosis, admitted between 2006 and 2014 in the Pediatric Intensive Care Unit (PICU) of Hospital de Santa Maria (HSM). The analysis was conducted by accessing computerized patient data. Results: Thirteen children met the diagnostic criteria with a median age of 13 years old and a mean hospital stay of 9,6 days. The most frequent etiology was drug use (n = 5). Abdominal pain was present in every child, most frequently being reported as diffuse abdominal pain (n = 4). Amylase and lipase were elevated in 11 and five of the cases, respectively. Pleural effusion was the most frequent complication and pancreatic edema was the most common finding in imaging studies. In the first 48 hours, seven of the children presented with criteria of severe pancreatitis (DeBanto et al score). Bowel rest lasted on average 2,71 days. Antibiotic therapy was started in nine children. There were no deaths reported. Conclusions: Attending to the high number of oncologic patients, drug use was the most frequent etiology. Despite seven patients filling the severity criteria in the first 48h, there were no deaths reported. The early start of fluid therapy constituted one of the support measures which were implemented to all patients and the feeding process was started in all cases by the enteral route. Antibiotic therapy was only started in children with a clinical suspicion of infection.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Pancreatite aguda Pediatria