肠功能障碍时间联合感染可能性评分对胰腺坏死组织感染预测价值  

Value of duration of intestinal dysfunction combined with infection probability score for predicting infected pancreatic necrosisi in acute necrotizing pancreatitis

作　　者：杨加鹏 何静妮[1] 张明杰[1] 陈建嘉 田忠[1] YANG Jia-peng;HE Jing-ni;ZHANG Ming-jie;CHEN Jian-jia;TIAN Zhong(Tenth Department of General Surgery,Affiliated Shengjing Hospital,China Medical University,Shenyang,110000,China)

机构地区：[1]中国医科大学附属盛京医院第十普通外科,辽宁沈阳110000 [2]辽阳市中心医院新城医院普外一科,辽宁辽阳111000

出　　处：《创伤与急危重病医学》2020年第5期317-321,共5页Trauma and Critical Care Medicine

基　　金：辽宁省自然科学基金(2019-ZD-0745)。

摘　　要：目的探讨持续肠功能障碍时间联合感染可能性评分(IPS)对急性坏死性胰腺炎(ANP)继发胰腺及胰周坏死组织感染(IPN)的预测价值。方法选取自2013年1月至2015年12月中国医科大学附属盛京医院收治的132例ANP患者为研究对象。采用受试者工作特征(ROC)曲线、多因素回归分析入院时患者IPS评分联合持续肠功能障碍时间对ANP继发IPN的预测价值。结果本研究共纳入132例ANP患者,其中,42例继发IPN,发生率为31.8%(42/132)。ANP继发IPN的发生与患者入院时的白细胞、血糖、血钙、AST水平、IPS以及入院后持续肠功能障碍时间密切相关。入院时,高IPS评分及入院后持续长时间的肠功能障碍是ANP继发IPN的独立危险因素。当入院时IPS评分≥13分、入院后持续肠功能障碍时间≥5 d时,ANP继发IPN的可能性最大。而入院时IPS评分联合持续肠功能障碍时间对ANP继发IPN的预测价值更佳,其ROC曲线下面积为0.80。结论持续肠功能障碍时间联合IPS评分预测ANP继发IPN的效能较佳。Objective To investigate the predictive significance of the duration of intestinal dysfunction combined with infection probability score(IPS)for infected pancreatic necrosisi(IPN)in the patients with acute necrotizing pancreatitis(ANP).Methods A retrospective study was performed on 132 cases of patients with ANP who were admitted from January 2013 to December 2015.The receiver operating characteristic(ROC)curve and multivariate regression analysis were used to analyze the predictive value of IPS score on admission combined with duration of persistent intestinal dysfunction for ANP secondary IPN.Results A total of 132 patients with ANP were included in this study.The incidence of secondary IPN was 31.8%(42/132)in 42 cases.The occurrence of ANP concomitant IPN was closely related to the white blood cell,blood glucose,blood calcium,AST level,IPS and duration of intestinal dysfunction after admission.At admission,high IPS score and persistent intestinal dysfunction are independent risk factors for ANP secondary IPN.When IPS score≥13 at admission and duration of continuous intestinal dysfunction≥5 days after admission,the possibility of secondary IPN of ANP was the highest.However,IPS score combined with duration of continuous intestinal dysfunction at admission had a better predictive value for ANP secondary IPN,and the area under the ROC curve was 0.80.Conclusion Duration of continuous intestinal dysfunction combined with IPS score predicted better efficacy of ANP secondary IPN.

关 键 词：肠功能障碍 感染可能性评分 急性坏死性胰腺炎 胰腺坏死组织 感染 

分 类 号：R657.5[医药卫生—外科学]