急性胰腺炎并发急性呼吸衰竭的危险因素分析  

Risk factors for acute pancreatitis complicated with acute respiratory failure

作　　者：林燕 张发钦 李海涛[2] LIN Yan;ZHANG Fa-qin;LI Hai-tao(Department of Gastroenterology,Fuzhou Second Affiliated Hospital of Xiamen University,Fuzhou,Fujian 350007,China)

机构地区：[1]厦门大学附属福州第二医院消化内科,福建福州350007 [2]解放军福州总医院消化内科,福建福州350025

出　　处：《中国临床研究》2018年第11期1500-1503,共4页Chinese Journal of Clinical Research

基　　金：福建省自然科学基金项目(2017J01321)

摘　　要：目的探讨急性胰腺炎并发急性呼吸衰竭(ARF)的危险因素,为临床急性胰腺炎危重类型的早期预测与及时有效救治提供参考。方法回顾性分析2016年1月至2018年3月收治的391例急性胰腺炎患者的临床资料,其中31例并发ARF(A组),360例未发生ARF(B组)。收集人口学特征、病因学诊断、基础疾病、是否吸烟、入院时急性生理学与慢性健康状况(APACHE)Ⅱ评分、住院时间、死亡等指标。对比两组患者住院时间和预后情况。通过单因素和多因素Logistic回归分析各临床指标与急性胰腺炎并发ARF之间的关联性。结果与B组比较,A组住院时间较长,局部并发症较多,死亡率较高(P均<0. 01)。单因素分析显示,急性胰腺炎并发ARF与性别、年龄、既往有无慢性阻塞性肺疾病、是否吸烟、入院24 h APACHEⅡ评分有关(P <0. 05,P <0. 01);而与体质指数、病因学类型无关(P均> 0. 05)。多因素Logistic回归分析发现,年龄≥50岁(OR=1. 07,95%CI:1. 05～1. 13,P=0. 017)、吸烟(OR=2. 36,95%CI:1. 35～6. 14,P=0. 005)和入院24 h APACHEⅡ评分≥5分(OR=2. 62,95%CI:1. 26～5. 75,P=0. 012)是急性胰腺炎并发ARF的独立危险因素(P <0. 05,P <0. 01)。结论急性胰腺炎并发ARF会增加患者住院时间和病死率,预后较差。年龄大、吸烟和入院24 h APACHEⅡ评分高是急性胰腺炎并发ARF会独立危险因素。Objective To explore the risk factors of acute respiratory failure（ARF） in acute pancreatitis（AP） and provide reference for early prediction of critical types and timely treatment of acute pancreatitis effectively. Methods The clinical data of 391 AP patients admitted to hospital from January 2016 to March 2018 were analyzed retrospectively,in whom 31 were complicated with ARF（A group）,and 360 were not complicated with ARF（B group）. Data of demographic characteristics,etiological diagnosis,basic diseases,smoking,acute physiology and chronic health enquiry（APACHE-Ⅱ）score at admission,hospital stay and mortality were collected. The hospitalization time and prognosis of the patients were compared between two groups. Univariate and multivariate logistic regression analysis methods were used to analyze the correlation between clinical indicators and ARF in acute pancreatitis. Results Compared with B group,hospital stay,local complications and mortality increased significantly in A group（all P〈0. 01）. Single factor analysis showed that ARF in acute pancreatitis was associated with sex,age,chronic obstructive pulmonary disease,smoking,and APACHE Ⅱ score of24 h after admission（P〈0. 05,P〈0. 01）,but was not associated with body mass index,and etiological type（P〉0. 05）.Multivariate logistic regression analysis showed that older age（OR = 1. 07,95% CI：1. 05-1. 13,P = 0. 017）,smoking（OR = 2. 36,95% CI：1. 35-6. 14,P = 0. 005） and higher APACHE Ⅱ score of 24 h after admission（OR = 2. 62,95%CI：1. 26-5. 75,P = 0. 012） were the independent risk factors for AP complicated with ABF（P〈0. 05,P〈0. 01）.Conclusions ARF in acute pancreatitis increases hospital stay and mortality,and the prognosis of patients is poor. Old age,smoking and high APACHE Ⅱ score of 24 h after admission are the independent risk factors for ARF in acute pancreatitis.

关 键 词：急性胰腺炎 急性呼吸衰竭 急性呼吸窘迫综合征 年龄 吸烟 APACHEⅡ评分 

分 类 号：R657.51[医药卫生—外科学]