重症急性胰腺炎并发急性肺损伤危险因素的临床研究  

Study on risk factors of severe pancreatitis complicated with lung injury

作　　者：陈秋星[1] 吕德超[1] 曹斌[1] 曹荣格[1] 叶宁[1] 陈东[1] 卢华东[1] 

机构地区：[1]安徽医科大学附属安徽省立医院急诊外科,安徽合肥230001

出　　处：《肝胆胰外科杂志》2012年第6期451-454,458,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨重症急性胰腺炎(SAP)患者急性期急性肺损伤(ALI)的危险因素。方法对2008年1月至2011年12月107例SAP患者进行回顾性分析,观察其不同CT分级、入院24 h内生理学指标、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分以及全身炎症反应综合征(SIRS)持续时间与肺损伤的相关性,并采用单因素x2检验及非条件多因素Logistic回归分析导致肺损伤的危险因素。结果 107例SAP患者并发ALI 39例,其中发生ARDS 16例。ALI/ARDS的发生与SAP的病因、病史时间、CT分级、SIRS、APACHEⅡ分值、Ca2+浓度、白蛋白浓度(ALB)、血糖浓度(GLU)、白细胞计数(WBC)及中性粒细胞计数(PMN)明显相关。进入非条件多因素Logistic回归分析的因素有白蛋白浓度、Ca2+浓度以及SIRS。结论本组资料SAP的ALI/ARDS发病率为36.45%,白蛋白浓度、Ca2+浓度及SIRS是SAP并发ALI的独立危险因素。Objeetive To explore risk factors of severe acute pancreatitis （SAP） complicated with acute lung injury（ALI） in the acute phase. Methods A retrospective analysis was conducted in 107 patients, the variables included the different CT types, physiological index in 24 h after admission, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and duration of the systemic inflammatory response syndrome （SIRS）. The correlation of acute lung iniurv with these variables was studied, and the independent risk factors of acute lung injury in SAP were explored using the single factor chi-square test analysis and unconditional multivariate Logistic regression analysis. Results Thirty- nine cases developed to acute lung iniurv in 107 SAP patients, and ARDS occurred in 16 cases. There was a significant correlation between ALI/ARDS occurrence and the cause of SAP, medical history, CT classification, SIRS time, APACHE Ⅱ score, calcium ion （Ca2＋） concentration, albumin （ALB） concentration, blood sugar concentration （GLU）, white blood cell count （WBC） and nentrophils count （PMN）. Albumin concentration, calcium ion concentration and SIRS went into unconditional multivariate Logistic regression analysis equation. Conclusion The study shows the ALI/ ARDS incidence in SAP is 36.45%. ALB concentration, Ca2＋ concentration and SIRS are independent risk factors of SAP complicated with ALI.

关 键 词：重症急性胰腺炎 急性肺损伤 全身炎症反应综合征 危险因素 

分 类 号：R657.5[医药卫生—外科学]