重症急性胰腺炎患者腹腔出血特点及其对预后的影响  

Characteristics of abdominal hemorrhage in patients with severe acute pancreatitis and its influence on outcomes

作　　者：付豹 范中红 高飞 苏德 胡杰 耿争光 傅小云 Fu Bao;Fan Zhonghong;Gao Fei;Su De;Hu Jie;Geng Zhengguang;Fu Xiaoyun(Department of Critical Care Medicine,Affiliated Hospital of Zunyi Medical University,Diagnosis and Treatment Center for Severe Acute Pancreatitis of Guizhou Province,Guiyang 563003,Guizhou,China;Department of Critical Care Medicine,Dejiang People's Hospital,Tongren 565200,Guizhou,China)

机构地区：[1]遵义医科大学附属医院重症医学科,贵州省重症急性胰腺炎诊疗中心,贵州遵义563003 [2]德江县人民医院重症医学科,贵州铜仁565200

出　　处：《中华危重病急救医学》2022年第1期70-74,共5页Chinese Critical Care Medicine

基　　金：贵州省科学技术基金(2010-2180)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者腹腔出血(AH)的危险因素及其对预后的影响。方法回顾分析贵州省SAP诊疗中心2015年1月1日至2019年12月31日收治的231例SAP患者的临床资料。根据是否发生AH分为AH组和非AH组,对比两组患者的一般资料、病因、入科时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、器官功能衰竭累及情况、并发症、干预措施、出血时间、出血部位和预后指标;采用二分类多因素Logistic回归法分析SAP患者发生AH的危险因素,以及AH发生时间和部位是否为预后的危险因素。结果231例患者均纳入分析,其中198例未发生AH,33例发生AH,AH发生率为14.3%。两组患者性别、年龄和病因差异均无统计学意义。与非AH组比较,AH组患者入科时APACHEⅡ评分和SOFA评分更高〔APACHEⅡ评分(分):18(12,24)比13(9,19),SOFA评分(分):9(5,15)比5(4,11),均P<0.01〕,急性肾损伤(AKI)、胃肠功能障碍、凝血功能异常、感染性坏死、假性囊肿和消化道瘘的发生率更高(66.7%比47.0%,36.4%比7.1%,18.2%比6.6%,66.7%比9.1%,66.7%比34.3%,9.1%比1.5%,均P<0.05),且患者需要机械通气(MV)和外科干预比例亦更高(69.7%比43.4,48.5%比14.6%,均P<0.01)。AH组患者重症监护病房(ICU)住院时间和总住院时间均较非AH组明显延长〔ICU住院时间(d):13(8,19)比7(3,16),总住院时间(d):24(13,40)比17(12,24),均P<0.01〕,住院病死率较非AH组显著升高(60.6%比9.6%,P<0.01)。多因素Logistic回归分析显示,APACHEⅡ评分〔优势比(OR)=1.157,95%可信区间(95%CI)为1.030~1.299,P=0.014〕、感染性坏死(OR=12.211,95%CI为4.063~36.697,P<0.001)、假性囊肿(OR=3.568,95%CI为1.238~10.283,P=0.019)和需MV(OR=0.089,95%CI为1.354~6.625,P=0.007)是SAP患者发生AH的独立危险因素。33例AH患者中,早期出血组(发病2周内)与晚期出血组(发病2周后)住院病死率差异无统计学意义〔66.7%(8/12)比57.1%(12/21),P>0.05〕。出血部位未�Objective To explore the risk factors of abdominal hemorrhage(AH)in patients with severe acute pancreatitis(SAP)and its impact on outcome.Methods The clinical data of 231 SAP patients admitted to Diagnosis and Treatment Center for SAP of Guizhou Province from January 1,2015 to December 31,2019 were retrospectively analyzed.These patients were divided into AH group and non-AH group.The general information,etiology,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,organ failure,complications,interventions,bleeding time,bleeding site and outcome were compared between the two groups.Binary multivariate Logistic regression analysis was used to explore the risk factors of AH in SAP patients and whether the time and location of AH were risk factors affecting the outcome.Results A total of 231 patients were enrolled in the analysis,including 198 patients without AH and 33 with AH(14.3%).There was no significant difference in gender,age or etiology between the two groups.The scores of APACHEⅡand SOFA in AH group were significantly higher than those in non-AH group[APACHEⅡscore:18(12,24)vs.13(9,19),SOFA score:9(5,15)vs.5(4,11),both P<0.01].The incidences of acute kidney injury(AKI),gastrointestinal dysfunction,coagulation disorders,necrotic infection,pseudocyst and gastrointestinal fistula in AH group were significantly higher than those in non-AH group(66.7%vs.47.0%,36.4%vs.7.1%,18.2%vs.6.6%,66.7%vs.9.1%,66.7%vs.34.3%,9.1%vs.1.5%,all P<0.05).The proportions of requiring mechanical ventilation(MV)and surgical intervention in AH group were significantly higher than those in non-AH group(69.7%vs.43.4,48.5%vs.14.6%,both P<0.01).The length of intensive care unit(ICU)stay and hospital stay in AH group were significantly longer than those in non-AH group[length of ICU stay(days):13(8,19)vs.7(3,16),length of hospital stay:24(13,40)vs.17(12,24),both P<0.01],and the hospital mortality was significantly higher(60.6%vs.9.6%,P<0.01).Multivariate Logistic regression ana

关 键 词：重症急性胰腺炎 腹腔出血 预后 感染性坏死 

分 类 号：R576[医药卫生—消化系统]