重症急性胰腺炎患者住院死亡因素的早期评估  

Nosocomial mortality and early assessment of patients with severe acute pancreatitis

作　　者：王心[1] 崔云峰[2] 苗彬[2] 张大鹏[2] 赵二鹏[2] 李忠廉[2] 崔乃强[2] 

机构地区：[1]天津医科大学2006级硕士研究生,天津300070 [2]天津市南开医院第二外科

出　　处：《中华急诊医学杂志》2009年第11期1146-1150,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨早期评估重症急性胰腺炎（severe aeute pancreatitis，SAP）患者住院期间死亡的相关因素，重点讨论血清胆固醇对SAP预后的影响。方法依据2003年中华医学会消化病学分会胰腺病学组制定的“中国急性胰腺炎诊治指南”，回顾性分析南开医院1999年1月-2008年12月间诊断为SAP的住院患者338例，所有患者均在发病72h内收住院，将患者按照死亡与否分为死亡组与存活组两组，且两组资料具有可比性，所有患者入院后24h内均抽静脉血进行血常规、血生化及CT检查，并对这些因素进行单因素及Logistic多因素回归分析。结果经Logistic回归分析，与血总胆固醇（Totalcholesterol，TC）浓度≤3．67mmol／L相比，TC农度3．67～4．37mmol／L，OR=0．664，P=0．412；TC4.37—5．23mmol／L，OR=0．144，P=0．021；TC≥5．23mmol／L时，OR=1．013，P=0．018，血CRP浓度随着血TC浓度的上升而下降。C-反应蛋白（C—reactive protein，CRP）≥170时，OR=7．074，P=0．031；血白蛋白（albumin，ALB）≤30时OR=7．224，P=0．029。结论CRP，ALB，TC均可早期预测SAP患者住院病死率；血TC4．37～5．23mmol／L为降低死亡优势的保护性因素，TC≤3．67nmlol／L或TC≥5．23mmol／L为增加死亡优势的危险因素；高CRP血症、低ALB血症为增加死亡优势的危险因素，低ALB血症的危险性高于高CRP血症；血胆固醇适量增加可以对抗炎症反应，提高住院患者存活率，进而降低住院病死率。Objective To analyze risk factors in order to predict the in-hospital mortality of patients with severe acute pancreatitis （SAP）, especially the factor of total cholesterol. Method Factors for predicting in-hospital mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classification of Acute Pancreatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Chi-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 retool/L, when the TC was between 3.67 - 4.37 mmol/L, OR was 0. 664 （ P = 0. 412）, while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 （P =0.021）.The OR was 1.013 （P = 0.018） when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein （CRP）. When the CRP was ≥170 mg/L, OR was 7.074 （P = 0.031）. When the serum ALB≤30 g/L, OR was 7.224 （P = 0.029）. Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 retool/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP〉 170 mg/L or ALB 〈 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to increase the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

关 键 词：重症急性胰腺炎 死亡因素 早期 住院病死率 

分 类 号：R576[医药卫生—消化系统]