重症急性胰腺炎合并糖尿病患者早期并发感染的相关危险因素  

Risk factors for early infection in patients with severe acute pancreatitis complicated with diabetes mellitus

作　　者：沈云志[1] 郭欣[1] 白彧[1] 

机构地区：[1]天津市第三中心医院肝胆外科,天津市300170

出　　处：《世界华人消化杂志》2015年第31期5064-5069,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨重症急性胰腺炎(severe acute pancreatitis,SAP)合并糖尿病(diabetesmellitus,DM)患者早期并发感染的危险因素,以降低感染率及死亡率.方法:回顾性分析2009-06/2014-01于天津市第三中心医院收治的86例SAP合并DM患者资料,按早期对症支持治疗过程中是否并发感染分为感染组(38例)及非感染组(48例).采用多因素Logistic回归的方法对感染的危险因素进行分析.结果:单因素分析显示急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分评分、胆源性致病因素、禁食时间、低氧血症、血肌酐升高、降钙素原、C-反应蛋白、机械通气、及抗生素的使用与SAP合并DM早期并发感染有统计学关联.Logistic多因素回归分析结果显示,APACHEⅡ评分≥11分(OR=9.793)、低氧血症(OR=5.202)、禁食时间>7 d(O R=1.476)、降钙素原升高(OR=6.861)和抗生素的使用(OR=4.125)是S A P合并D M患者早期合并感染的独立危险因素.结论:SAP合并DM患者早期并发感染与多种因素紧密相关,临床上应针对易感因素进行干预,减少感染风险,降低死亡率.AIM：To investigate the risk factors for early complications in patients with severe acute pancreatitis（SAP） complicated with diabetes mellitus（DM）.METHODS：Eighty-six patients with SAP complicated with DM treated at our hospital from June 2009 to January 2014 were retrospectively analyzed.According to the presence of infection episodes or not during early symptomatic treatment,the patients were divided into either an infection group（38 cases）or a non-infection group（48 cases）.The risk factors for early infection were identified by Logistic regression analysis.RESULTS：Univariate analysis showed that acute physiology and chronic health evaluationⅡ（APACHE Ⅱ） score,biliary pathogenic factors,fasting time,hyoxemia,high serum creatinine,procalcitonin（PCT）,C-reactive protein（CRP）,mechanical ventilation and the use of antibiotics were statistically associated with early infection.Logistic multivariate regression analysis showed that APACHE Ⅱ score 〉11（OR = 9.793）,hyoxemia（OR = 5.202）,fasting time 〉7 d（OR = 1.476）,increased PCT（OR = 6.861） and the use of antibiotics（OR =4.125） were independent risk factors for early infection in patients with SAP combined with DM.CONCLUSION：The development of early infection in SAP combined with DM is closely related with many risk factors,which should be aimed by doctors at early stage to reduce the risk of infection and mortality.

关 键 词：重症急性胰腺炎 糖尿病 感染 危险因素 

分 类 号：R576[医药卫生—消化系统] R587.2[医药卫生—内科学]