重症急性胰腺炎并发腹腔感染患者预后的影响因素分析
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摘要
目的分析影响重症急性胰腺炎(SAP)并发腹腔感染(AIC)患者预后的危险因素,以期为临床治疗提供指导。方法收集2016年2月至2018年2月在南充市中心医院就诊的131例SAP并发AIC患者的临床资料,按预后将患者分为存活组与死亡组,比较两组临床资料的差异,并应用Logistic回归模型分析影响预后的危险因素。结果 131例患者,平均住院时间(33.58±10.67)d,入住ICU时间(6.37±4.29)d,存活103例(78.63%),死亡28例(21.37%)。与存活组相比,死亡组器官障碍数目≥2个、膀胱压>25mm Hg、白细胞计数(WBC)、红细胞压积、总胆固醇、甘油三酯(TG)、急性生理学与慢性健康状况评分(APACHEⅡ)、Ranson评分均更高(P<0.05),血氧分压较低(P<0.05)。多因素Logistic回归分析显示,器官障碍数目是否≥2个、膀胱压是否>25mm Hg及血氧分压、WBC、TG、APACHEⅡ评分均是SAP并发AIC死亡的影响因素(P<0.05)。结论 SAP并发AIC患者病死率较高,当出现器官障碍数目≥2个、血氧分压降低及膀胱压、WBC、TG、APACHEⅡ评分增高时提示预后不良,应引起充分重视。
Objective To analyze the risk factors influencing the prognosis of patients with severe acute pancreatitis(SAP)and abdominal infection complication(AIC)so as to provide guidance for the clinical treatment.Methods The clinical data of 131 patients with SAP and AIC treated in Nanchong Central Hospital from February of 2016 to February of 2018 were collected.Those patients were divided into the survival group and the death group according to the prognostic results.The clinical data were compared between the two groups and the Logistic regression model was used to analyze the risk factors influencing the prognosis.Results Among the 131 patients,the average length of hospital stay and the length of stay in ICU were(33.58±10.67)d and(6.37±4.29)d respectively with 103 surviving cases(78.63%)and 28 dead cases(21.37%).The proportions of patients with no less than two organ disorders and patients with bladder pressure higher than 25 mm Hg,white blood cell(WBC)count,and scores of acute physiology and chronic health evaluation II(APACHE II)and Ranson levels of hematocrit,total cholesterol and triglyceride(TG),in the death group were all significantly higher than those in the survival group(P<0.05),while the partial pressure of blood oxygen in the death group was significantly lower than that in the survival group(P<0.05).The results of multivariate logistic regression analysis showed that the number of organ disorders,bladder pressure,partial pressure of blood oxygen,WBC,TG and APACHE II score were the factors influencing the prognosis of patients with SAP and AIC(P<0.05).Conclusion The mortality of patients with SAP and AIC is relatively high.The appearance of no less than two organ disorders,decrease of partial pressure of blood oxygen and increase of WBC,TG,and APACHE II score indicate the poor prognosis,which should be paid enough attention.
Objective To analyze the risk factors influencing the prognosis of patients with severe acute pancreatitis(SAP)and abdominal infection complication(AIC)so as to provide guidance for the clinical treatment.Methods The clinical data of 131 patients with SAP and AIC treated in Nanchong Central Hospital from February of 2016 to February of 2018 were collected.Those patients were divided into the survival group and the death group according to the prognostic results.The clinical data were compared between the two groups and the Logistic regression model was used to analyze the risk factors influencing the prognosis.Results Among the 131 patients,the average length of hospital stay and the length of stay in ICU were(33.58±10.67)d and(6.37±4.29)d respectively with 103 surviving cases(78.63%)and 28 dead cases(21.37%).The proportions of patients with no less than two organ disorders and patients with bladder pressure higher than 25 mm Hg,white blood cell(WBC)count,and scores of acute physiology and chronic health evaluation II(APACHE II)and Ranson levels of hematocrit,total cholesterol and triglyceride(TG),in the death group were all significantly higher than those in the survival group(P<0.05),while the partial pressure of blood oxygen in the death group was significantly lower than that in the survival group(P<0.05).The results of multivariate logistic regression analysis showed that the number of organ disorders,bladder pressure,partial pressure of blood oxygen,WBC,TG and APACHE II score were the factors influencing the prognosis of patients with SAP and AIC(P<0.05).Conclusion The mortality of patients with SAP and AIC is relatively high.The appearance of no less than two organ disorders,decrease of partial pressure of blood oxygen and increase of WBC,TG,and APACHE II score indicate the poor prognosis,which should be paid enough attention.
引文
[1]孙兴,方兆山,陶海粟,等.腹腔镜腹腔置管灌洗引流治疗重症急性胰腺炎87例[J].实用医学杂志,2016,32(6):903-907.
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[10]李建平,蔡强,浦建康,等.腹内压值对外科急腹症患者的检测价值研究[J].现代生物医学进展,2016,16(16):3150-3153.
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[12]Radenkovic D V,Johnson C D,Milic N,et al.Interventional treatment of abdominal compartment syndrome during severe acute pancreatitis:current status and historical perspective[J].Gastroenterol Res Pract,2016,2016:5251806.
[13]汪俏妹,罗明武,肖冰.临床检验指标对急性胰腺炎并发症与预后的评估价值[J].广东医学,2017,38(14):2180-2183.
[14]陈瑶,张中伟,王波,等.早期血浆白蛋白变异对ICU重症急性胰腺炎患者预后评估的价值[J].四川大学学报(医学版),2013,44(2):237-241.
[15]游红勇,陈智敏,白燕,等.急性重症胰腺炎患者血脂水平变化及预后不良的危险因素分析[J].广西医学,2014,36(7):905-907.
[16]李力,黄玲,徐萍,等.重症急性胰腺炎预后危险因素分析[J].中华胰腺病杂志,2015,15(3):150-153.
[17]Wu W H,Niu Y Y,Zhang C R,et al.Combined APACH IIscore and arterial blood lactate clearance rate to predict the prognosis of ARDS patients[J].Asian Pac J Trop Med,2012,5(8):656-660.
[18]Agarwal S,George J,Padhan R K,et al.Reduction in mortality in severe acute pancreatitis:a time trend analysis over 16years[J].Pancreatology,2016,16(2):194-199.
[2]沈绚丽,杨建锋,楼立兰.经皮穿刺腹腔置管引流治疗重症急性胰腺炎并发腹腔感染的效果分析[J].中华医院感染学杂志,2014,24(6):1491-1493.
[3]王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013,上海)[J].中国实用内科杂志,2013,33(7):530-535.
[4]Hao F B,Guo H J,Luo Q F,et al.Disease progression of acute pancreatitis in pediatric patients[J].J Surg Res,2016,202(2):422-427.
[5]Puiggròs C,Molinos R,Ortiz M D,et al.Experience in bedside placement,clinical validity,and cost-efficacy of a self-propelled nasojejunal feeding tube[J].Nutr Clin Pract,2015,30(6):815-823.
[6]Isenmann R,Rau B,Beger H G.Early severe acute pancreatitis:characteristics of a new subgroup[J].Pancreas,2001,22(3):274-278.
[7]Johnson C D,Abu-Hilal M.Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis[J].Gut,2004,53(9):1340-1344.
[8]沈凯,张立军,李洁,等.重症急性胰腺炎预后影响因素分析[J].河北医药,2017,39(5):660-662,667.
[9]李萌芳,任晓蕊,支绍册,等.老年重症急性胰腺炎患者的临床特点及预后分析[J].医学研究杂志,2017,46(1):84-87.
[10]李建平,蔡强,浦建康,等.腹内压值对外科急腹症患者的检测价值研究[J].现代生物医学进展,2016,16(16):3150-3153.
[11]Rodriguez J R,Razo A O,Targarona J,et al.Debridement and closed packing for sterile or infected necrotizing pancreatitis:insights into indications and outcomes in 167patients[J].Ann Surg,2008,247(2):294-299.
[12]Radenkovic D V,Johnson C D,Milic N,et al.Interventional treatment of abdominal compartment syndrome during severe acute pancreatitis:current status and historical perspective[J].Gastroenterol Res Pract,2016,2016:5251806.
[13]汪俏妹,罗明武,肖冰.临床检验指标对急性胰腺炎并发症与预后的评估价值[J].广东医学,2017,38(14):2180-2183.
[14]陈瑶,张中伟,王波,等.早期血浆白蛋白变异对ICU重症急性胰腺炎患者预后评估的价值[J].四川大学学报(医学版),2013,44(2):237-241.
[15]游红勇,陈智敏,白燕,等.急性重症胰腺炎患者血脂水平变化及预后不良的危险因素分析[J].广西医学,2014,36(7):905-907.
[16]李力,黄玲,徐萍,等.重症急性胰腺炎预后危险因素分析[J].中华胰腺病杂志,2015,15(3):150-153.
[17]Wu W H,Niu Y Y,Zhang C R,et al.Combined APACH IIscore and arterial blood lactate clearance rate to predict the prognosis of ARDS patients[J].Asian Pac J Trop Med,2012,5(8):656-660.
[18]Agarwal S,George J,Padhan R K,et al.Reduction in mortality in severe acute pancreatitis:a time trend analysis over 16years[J].Pancreatology,2016,16(2):194-199.