并发单器官衰竭的急性胰腺炎临床和预后特点  

Clinical and prognostic features of acute pancreatitis complicated with specific single organ failure

作　　者：王育斌[1] 张长青[1] 张葵玲[1] 周阿佩 Wang Yu - bin;Zhang Chang - qing;Zhang Kui - ling;Zhou A - pei.(Department of Gastroenterology, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Chin)

机构地区：[1]福建医科大学附属泉州第一医院消化内科,福建泉州362000

出　　处：《中国急救医学》2018年第4期332-336,共5页Chinese Journal of Critical Care Medicine

基　　金：泉州市卫生计生科研资助项目（2009279）;泉州市第一医院青年科研课题（35）

摘　　要：目的 探讨并发单器官衰竭的急性胰腺炎（AP）临床和预后特点。方法 回顾性分析2012-07-2017-06福建医科大学附属泉州第一医院135例并发器官衰竭的AP患者临床和预后资料，根据器官衰竭的数目，分为单器官衰竭和多器官衰竭（2个及以上）。统计单器官衰竭在所有器官衰竭AP患者中所占的比例，单器官衰竭中最常好发的脏器种类，中度急性胰腺炎（MSAP）和重度急性胰腺炎（SAP）表现为单器官衰竭的各自比例，不同脏器发生单器官衰竭时在一般资料（性别、年龄、病因诊断）、APACHEⅡ评分、ICU入住率、ICU入住时间、住院天数和病死率方面的异同。结果 本组135例并发器官衰竭的AP患者中属于MSAP为80例，SAP为55例，表现为单器官衰竭者99例（73.3%，99/135），多器官衰竭者36例（26.7%，36/135）。MSAP和SAP表现为单器官衰竭的比例分别为80.0%（64/80）和63.6%（35/55），MSAP表现为单器官衰竭的比例更高（χ2=4.463, P=0.035）。单器官衰竭中最常见的类型依次为呼吸衰竭（68.7%, 68/99）、肾衰竭（28.3%, 28/99）和循环衰竭（3.0%，3/99），MSAP和SAP中单器官衰竭的各种类型比例相似（χ2=0.191, P=0.909）。与单发肾衰竭相比，单发呼吸衰竭的AP患者APACHEⅡ评分（MSAP：8.6±3.5 vs. 6.5±2.9，t=2.288, P=0.026; SAP： 15.9±5.7 vs. 11.2±4.8，t=2.203, P=0.035）、ICU入住率（MSAP： 55.8% vs. 26.3%， χ2=4.606, P=0.032； SAP： 100% vs. 55.6%，χ2=12.593, P＜0.001）、ICU入住时间（MSAP： 5.2±3.1 vs. 1.8±2.0, t=2.334, P=0.027; SAP： 12.2±6.3 vs. 4.1±2.4，t=2.801, P=0.009）显著增高，一般资料、住院时间和病死率差异无统计学意义。结论 MSAP患者表现为单器官衰竭的比例更高，其中最常见的为单发呼吸衰竭和单发肾衰竭。相对单发肾衰竭而言，单发呼吸衰竭更加危重，更需加强重症监护。Objective To investigate the clinical and prognostic features of acute pancreatitis （AP） complicated with specific single organ failure. Methods The clinical and prognostic data of a total of 135 patients with AP and developed organ failure in our hospital in the past 5 years during July 2012 to June 2017, were retrospectively analyzed. The specific single organ failure and multiple organ failure （2 or more） were defined and divided according to the number of failed organs. The proportion of specific single organ failure in all the AP patients with organ failure, and in MSAP and SAP were measured respectively. The frequency of different specific single organ failure, the demographic and clinical parameters such as gender, age, etiology, APACHE II score, rate of ICU admission, length of stay in ICU and hospital, and mortality were compared among the patients with different specific single organ failure. Results Among the 135 patients of AP with organ failure, 80 cases belonged to MSAP, and 55 cases belonged to SAP. The specific single organ failure occurred in 99 patients, and multiple organ failure in 36 patients. The proportion of specific single organ failure in MSAP, SAP and MSAP ＋ SAP was 80% （64/80）, 63.6% （35/55） and 73.3% （99/135） retrospectively. MSAP showed a higher proportion of specific single organ failure （X2 = 4. 463, P = 0. 035 ）. The frequency of different specific single organ failure was respectively 68.7% （ 68/99 ） for pulmonary failure, 28.3% （ 28/99 ） for renal failure, and 3% （3/99） for circulatory failure. The frequency of different specific single organ failure in MSAP and SAP were similar （X2 = 0. 191, P = 0. 909）. Compared with the solitary renal failure, the APACHEII score （MSAP： 8.6 ±3.5 vs. 6.5 ±2.9, t =2.288, P=0.026; SAP： 15.9 ± 5.7 vs. 11.2 ±4.8, t =2. 203, P=0.035）, ICU admission （MSAP： 55.8% vs. 26.3%,X2 = 4.606, P=0.032; SAP： 100% vs. 55.6% ,X2 =12.593, P〈 0.001）, and ICU stay （MSAP： 5.2 ± 3.1 vs. 1.8 ±2.0, t=

关 键 词：急性胰腺炎(AP) 器官衰竭 单器官衰竭 肾衰竭 呼吸衰竭 

分 类 号：R59[医药卫生—内科学]