重症急性胰腺炎死亡的高危因素分析  

Analysis of fatal risk factors for severe acute pancreatitis:a report of 141 cases

作　　者：孙备[1] 董承刚 王刚[1] 姜洪池[1] 孟庆辉[1] 李军[1] 刘杰[1] 武林枫[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院肝胆胰外科,150001 [2]内蒙古呼伦贝尔市人民医院普外科

出　　处：《中华外科杂志》2007年第23期1619-1622,共4页Chinese Journal of Surgery

基　　金：黑龙江省自然科学基金(D200539);黑龙江省教育厅科学技术研究资助项目(11521127)

摘　　要：目的探讨与重症急性胰腺炎(SAP)死亡相关的高危因素。方法回顾性分析2001年1月至2005年10月收治的141例 SAP 患者的临床资料。将患者分为死亡组和生存组,对可能影响 SAP 预后的15个因素采用 Logistic 回归分析。结果 141例 SAP 患者中死亡34例(24.1%)。死亡组患者在年龄、体重指数、住院时间、APACHEⅡ评分和并发多器官功能障碍综合征(MODS)、腹腔室隔综合征(ACS)等方面与生存组相比差异有统计学意义(P<0.05)。多因素分析显示,MODS(OR=67.358,P<0.01)、APACHEⅡ评分(OR=9.716,P<0.01)和 ACS(OR=5.775,P<0.05)是早期影响 SAP 预后的独立危险因素;胰腺感染(OR=9.652,P<0.01)、MODS(OR=5.212,P<0.05)和腹腔出血(OR=4.707,P<0.05)则是后期影响 SAP 预后的独立危险因素。结论 SAP 早期死亡的主要原因是 MODS,特别是呼吸功能障碍和肾功能障碍,而后期死亡的主要原因是感染、MODS 和腹腔出血。对高危因素进行早期预防和及时处理是降低 SAP 病死率的关键。Objective To investigate the risk factors affecting the mortality of severe acute pancreatitis（SAP）. Methods The clinical data of 141 patients with SAP treated from January 2001 to October 2005 were analyzed retrospectively. All the patients were divided into 2 groups, the death group and the survival group. Fifteen potential factors influencing the prognosis of SAP were analyzed with Logistic regression analysis. Results Thirty-four cases （ 24. 1% ） among the 141 patients died. There were significant differences between the two groups in age, body mass index, length of stay, APACHE I1 score, multiple organ dysfunction syndrome （MODS） and abdominal compartment syndrome （ACS） （ P 〈 0. 05 ）. Multiple-factor Logistic regression analysis indicated that the MODS （ OR = 67. 358, P 〈 0. 01 ）, APACHE Ⅱ score （ OR = 9.716, P 〈 0. 01 ） and ACS （ OR = 5.775, P 〈 0.05 ） were the independent risk factors affecting the prognosis of SAP during its early stage, whereas pancreatic infection （ OR = 9. 652, P 〈 0. 01 ）, MODS （ OR = 5. 212, P 〈 0.05 ）and celiac hemorrhage （ OR = 4. 707, P 〈 0.05 ） were the independent risk factors during the advanced stage of SAP. Conclusions MODS, especially respiratory dysfunction and renal dysfunction, is the main cause of early mortality for SAP, whereas infection, multiple organ dysfunction and celiac hemorrhage may impact the later mortality. Therefore early prevention and correct management on the risk factors play critical roles in reducing the mortality of SAP.

关 键 词：胰腺炎 急性坏死性 预后 多器官功能障碍 感染 

分 类 号：R657.51[医药卫生—外科学]