重症急性胰腺炎合并低氧血症早期氧疗失败的临床特征和危险因素分析  

Clinical characteristics and risk factors of early oxygen therapy failure in patients with severe acute pancreatitis complicated with hypoxemia

作　　者：陶缘发 付朝晖[2] TAO Yuanfa;FU Zhaohui(Department of Pancreatology,Renmin Hospital of Wuhan University,Wuhan,Hubei,430060,China;Department of Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]武汉大学人民医院胰腺外科,武汉430060 [2]华中科技大学同济医学院附属协和医院重症医学科

出　　处：《临床急诊杂志》2021年第3期177-181,共5页Journal of Clinical Emergency

摘　　要：目的:探讨重症急性胰腺炎(SAP)合并低氧血症患者早期氧疗失败的临床特征和危险因素。方法:回顾性分析2014年7月-2019年12月期间初治的此类患者的临床资料,将早期(10 d内)氧疗失败组同对照组(未失败组)进行比较,挑选存在组间差异或临床意义的指标,纳入多因素Logistic回归进行分析,寻找氧疗失败的独立危险因素。结果:共纳入82例患者,男54例,女28例,平均年龄(41.2±10.9)岁,其中氧疗失败组43例,对照组39例。氧疗失败组出现氧疗失败的中位时间为3(2~7)d,接受机械通气时间为(9.3±3.5)d。氧疗失败组ICU住院天数比对照组延长,分别为(12.7±4.1)d和(7.1±2.8)d(P=0.000)。多因素Logistic回归显示,入院时PaO_(2)/FiO_(2)<150 mmHg预测氧疗失败的OR=1.38(95%CI:1.17~1.76),膀胱压≥20 mmHg预测氧疗失败的OR=1.34(95%CI:1.15~1.58)。结论:入院时PaO_(2)/FiO_(2)<150 mmHg,膀胱压≥20 mmHg是SAP合并低氧血症患者早期氧疗失败的独立危险因素。Objective: To investigate the clinical characteristics and risk factors of early oxygen therapy failure in patients with severe acute pancreatitis(SAP) complicated with hypoxemia. Methods: Data of patients with SAP complicated by hypoxemia was collected retrospectively from July 2014 to December 2019. Patients who failed in early oxygen therapy(less than 10 days after admission)were defined as Failure group,while the ones who succeed in that therapy were classified into Control group. Indicators with intergroup differences or clinical significance were selected into multiple logistic regression models, to explore the independent risk factors of oxygen therapy failure. Results: A total of 82 patients, including 54 males and 28 females, with an average age of 41.2±10.9 years, were included. Among them, 43 patients were in the Failure group and 39 patients in the Control group. In the Failure group, the median day for the onset of oxygen therapy failure was 3(2-7) days, and the duration of mechanical ventilation was 9.3±3.5 days. The length of stay in ICU in the Failure group was longer than that in the Control group[12.7±4.1 and 7.1±2.8 days, respectively(P=0.000)]. Multivariate Logistic regression showed that PaO_(2)/FiO_(2)<150 mmHg(OR=1.38,95%CI:1.17-1.76)and bladder pressure ≥20 mmHg(OR=1.34,95%CI:1.15-1.58)predicted oxygen therapy failure. Conclusion: PaO_(2)/FiO_(2)<150 mmHg and bladder pressure ≥20 mmHg on admission are independent risk factors for oxygen therapy failure in the early phase of patients with SAP complicated with hypoxemia.

关 键 词：重症急性胰腺炎 低氧血症 危险因素 临床特征 

分 类 号：R657.51[医药卫生—外科学]