重症急性胰腺炎并发胰腺炎相关肺损伤的危险因素分析  

The clinical study on risk factors of severe acute pancreatitis complicated with pancreatitis associated lung injury

作　　者：潘涛[1] 黄蕾[1] 冉红梅[1] 侯兵[1] 刘芙成[1] 

机构地区：[1]成都市第一人民医院消化内科,四川成都610041

出　　处：《实用医院临床杂志》2013年第5期91-94,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨重症急性胰腺炎（SeveFeacutepancreatitis，SAP）患者并发胰腺炎相关肺损伤（pancreatitis—associatedlunginjury，PALI）的危险因素。方法我院2010—2012年收治89例SAP患者，其中合并PALI（A组）29例，未合并PALI（B组）60例。对两组患者年龄、性别、病史及入院24小时内的呼吸频率、吸入氧浓度（FiO2）、C反应蛋白（CRP）、血糖、血钙、A—PACHEII评分、BalthazarCT评分等数据进行对比，采用多因素Logistic回归分析SAP并发PAu的危险因素。结果A组吸烟史、肥胖、胸腔积液、呼吸频率〉30次／分钟、血氧饱和度（SpO2）〈95％、Fi02〉35％、血清白蛋白〈30g／L、血pH〈7．35、血糖水平、Ranson评分和24hAPACHEⅡ评分高于B组（P〈0．05），但嗜酒史、C反应蛋白水平、血钙〈1．87mmol／L的发生率和BahhazarCT评分两组比较差异无统计学意义（P〉0．05）。多因素Logistic回归分析结果显示，吸烟史、肥胖、胸腔积液、SpO2〈95％、FiO2〉35％（〉4L／min）、血糖≥11．1mmol／L、低蛋白血症[血清白蛋白（ALB）〈30g／L]、24hAPACHEII评分≥12分是SAP并发PALI的可能危险因素。结论吸烟史、肥胖、胸腔积液、Sp02〈95％、Fi02〉35％、ALB〈30g／L、血糖≥11．1mmol／L和24hAPACHEⅡ评分≥12分可能是SAP并发PALI的危险因素，尚需前瞻性、大样本的随机对照研究进-步证实。Objective To study the risk factors of severe acute pancreatitis（ SAP）patients complicated with pancreatitis asso- ciated lung injury（PALI）. Methods 89 patients with SAP were retrospectively identified from 2010 to 2012 in our hospital,29 were in the PALI group（ A group）and 60 were in the non-PALI group （B group）. Age, sex, medical history, and respiratory rate within 24 hours of admission, FiO2, CRP, glucose, calcium, APACHE Ⅱ score, Balthazar CT score and other data of two groups of patients was collected and compared. Multivariate Logistic regression analysis of risk factors for SAP complicated with PALI. Results History of smoking,o- besity, pleural effusion, respiratory rate〉30, oxygen saturation （ SpO2 ） 〈 95 %, FiO2 〉 35 %, serum albumin 〈 30 g/L, the incidence of blood pH 〈 7. 35, glucose, Ranson score and 24 h APACHE II score of Group A was higher than group B （ P 〈 0. 05 ） ; But there was no statistically significant difference （P 〉 0. 05 ）between the two groups of history of alcohol, CRP, the incidence of serum calcium 〈 1.87 mmol/L and Balthazar CT score. Multivariate Logistic regression analysis showed that smoking history, obesity, pleural effusion, SpO2 〈 95% ,FIO2〉35% （ 〉4 L/min） ,blood glucose ≥ 11.1 mmol/L,hypoalbuminemia [ serum albumin（ALB） 〈 30 g/L] ,24 h APACHE II score ≥ 12 points were the possible risk factors of SAP complicated PALI. Conclusions Smoke history,obesity,pleural effusion,SpO2 〈 95%, FiO2 〉35% , ALB 〈 30 g/L, blood glucose ≥ 11.1 mmol/L and 24 h APACHE Ⅱ score ≥ 12 were the possible risk factors of SAP complicated with PALI,which should be further confirmed by prospective and large sample.randomized controlled study.

关 键 词：重症急性胰腺炎 急性肺损伤 危险因素 

分 类 号：R576[医药卫生—消化系统]