重症急性胰腺炎急性肾功能衰竭临床危险因素及其预防  

Risk factors of acute renal failure in severe acute pancreatitis and their prevention

作　　者：乔世峰[1] 孙家邦[1] 李非[1] 朱斌[1] 

机构地区：[1]首都医科大学宣武医院普外科

出　　处：《中华肝胆外科杂志》2005年第5期293-295,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究重症急性胰腺炎(severe acute pancreatitis,SAP)病人急性肾功能衰竭(acute renal failure,ARF)发生的易患因素,估价ARF与SAP病人预后的相关性,探讨预防ARF发生的措施。方法回顾性分析我院1990年以来收治的SAP病人246例,对病人年龄、性别、病因、Ranson评分、APACHEⅡ评分、低氧血症、腹腔室隔综合征、感染、血淀粉酶水平、尿淀粉酶水平、急诊手术、禁食天数、是否应用生长抑素等因素,进行多因素Logistic回归分析。结果246例SAP病人31例发生ARF,ARF的发病率为12.6%。ARF组APACHEⅡ评分明显高于无ARF组,两组比较有显著性差异。腹腔室隔综合征、低氧血症和急诊手术在两组之间比较有显著性差异。结论在SAP发病过程中,APACHEⅡ评分增高、低氧血症和腹腔室隔综合征可能是导致ARF发生的危险因素。维持病人全身状态稳定、防止肾脏低灌注损害、预防低氧血症的发生以及手术引流腹腔减压可能有预防ARF发生的作用。Objective To study the risk factors of acute renal failure(ARF) in severe acute pancreatitis(SAP),investigate the relationship between ARF and prognosis of SAP and explore the measures to prevent ARF.Methods The clinical and laboratory data including age,sex,pathogenesis,Ranson score,APACHE II score,hypoxemia,abdominal compartment syndrome,infection,serum amylase level,urine amylase level,emergency operation,fasting time and somatostatin in 246 patients with SAP treated in our hospital since 1990 were retrospectively analyzed using multiple logistic regression analysis.Results Thirty-one(12.6%) of the 246 patients with SAP developed ARF during the course of disease.APACHE II score was significantly higher in the patients with ARF than in those without.There were significant differences in hypoxemia,abdominal compartment syndrome and emergency operation between these 2 groups of patients.Conclusions APACHE II score,hypoxemia and abdominal compartment syndrome are the risk factors for ARF development in SAP.Reducing the abdominal pressure by maintenance of systemic stability,prevention of low perfusion injury and avoiding hypoxemia and emergency operation might be beneficial for prevention of ARF prevalence.

关 键 词：重症急性胰腺炎 危险因素及 多因素LOGISTIC回归分析 APACHEⅡ评分 急性肾功能衰竭(acute 预防 腹腔室隔综合征 failure 显著性差异 低氧血症 临床 ARF 急诊手术 renal 1990年 回顾性分析 SAP 易患因素 病人年龄 生长抑素 

分 类 号：R692.5[医药卫生—泌尿科学] R657.51[医药卫生—外科学]