腹腔开放治疗急性胰腺炎合并腹腔间隙综合征的临床疗效和预后影响因素分析  

Clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome

作　　者：施建设 郭冰泉 陈佳海 郑佳隆 胡清福 刘卉芳 马秀勇 艾叶青 潘志强 田新 叶勇[4] 陈一杰 王清茂 杜振双 张诚华 Shi Jianshe;Guo Bingquan;Chen Jiahai;Zheng Jialong;Hu Qingfu;Liu Huifang;Ma Xiuyong;Ai Yeqing;Pan Zhiqiang;Tian Xin;Ye Yong;Chen Yijie;Wang Qingmao;Du Zhenshuang;Zhang Chenghua(Department of General Surgery,the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Quanzhou 362008,China;Department of General Practice,the Second Affiliated Hospital of Fujian Medical University,Quanzhou 350108,China;Department of Pancreatitis Diagnosis and Treatment Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Surgical Intensive Care Unit,Fujian Provincial Hospital,Fuzhou 350013,China;Department of General Surgery,Shishi General Hospital,Quanzhou 362799,China;Department of General Medicine,People′s Hospital Affiliated to Quanzhou Medical College,Quanzhou 362018,China)

机构地区：[1]解放军联勤保障部队第910医院普通外科,泉州362008 [2]福建医科大学附属第二医院全科医学科,泉州350108 [3]温州医科大学附属第一医院胰腺炎诊治中心,温州325015 [4]福建省立医院SICU,福州350013 [5]石狮市总医院普通外科,泉州362799 [6]泉州医学高等专科学校附属人民医院全科医学科,泉州362018

出　　处：《中华消化外科杂志》2022年第4期520-529,共10页Chinese Journal of Digestive Surgery

基　　金：泉州市科技计划项目(2019C080R, 2021N003S)。

摘　　要：目的探讨腹腔开放治疗急性胰腺炎合并腹腔间隙综合征(ACS)的临床疗效和预后影响因素。方法采用回顾性队列研究方法。收集2013年1月至2020年12月国内6家医院收治的186例(解放军联勤保障部队第910医院65例, 温州医科大学附属第一医院46例, 福建省立医院33例, 福建医科大学附属第二医院31例, 泉州医学高等专科学校附属人民医院7例、石狮市总医院4例)急性胰腺炎合并ACS患者的临床资料;男142例, 女44例;年龄为(43±8)岁。观察指标:(1)患者腹腔开放治疗情况。(2)不同治疗结局患者临床特征分析。(3)不同治疗结局患者尿量、乳酸、肠内营养摄入量及序贯器官衰竭(SOFA)评分的变化趋势。(4)患者预后影响因素分析。正态分布的计量资料以x±s表示, 组间比较采用t检验。偏态分布的计量资料以M(Q1, Q3)表示, 组间比较采用Mann-WhitneyU检验。计数资料以绝对数表示, 组间比较采用χ^(2)检验或连续性校正χ^(2)检验。重复测量数据采用重复测量方差分析。相关性检验采用Spearman相关性分析。单因素分析采用COX回归模型, 多因素分析采用COX向前逐步回归模型。结果 (1)患者腹腔开放治疗情况。186例患者腹腔开放治疗前腹内压、氧合指数、乳酸、SOFA评分分别为(23.3±1.9)mmHg(1 mmHg=0.133 kPa)、(121±24)mmHg、(5.0±3.4)mmol/L、(10.4±3.6)分;治疗后168 h上述指标分别为(11.2±2.9)mmHg、(222±38)mmHg、(3.2±2.1)mmol/L、(4.4±2.3)分;两者上述指标时间效应比较, 差异均有统计学意义(F时间=855.26, 208.50, 174.91, 208.47, P<0.05)。(2)不同治疗结局患者临床特征分析。186例患者中, 166例住院期间生存并顺利出院, 20例住院期间死亡。腹腔开放治疗前, 住院期间生存患者年龄、SOFA评分、术前ACS持续时间、乳酸分别为(41±7)岁、(9.4±3.4)分、13(10, 21)h、(4.2±0.6)mmol/L;死亡患者上述指标分别为(45±6)岁、(11.5±2.4)分、65(39, 84)h、(5Objective To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome(ACS).Methods The retrospective cohort study was conducted.The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals,including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,46 cases in the First Affiliated Hospital of Wenzhou Medical University,33 cases in the Fujian Provincial Hospital,31 cases in the Second Affiliated Hospital of Fujian Medical University,7 cases in the People′s Hospital Affiliated to Quanzhou Medical College,4 cases in the Shishi General Hospital,from January 2013 to December 2020 were collected.There were 142 males and 44 females,aged(43±8)years.Observation indica-tors:(1)patients conditions after being treatment with open abdomen technique;(2)analysis of clinical characteristics in patients with different treatment outcomes;(3)changing trend of the volume of urine output,levels of lactic acid,levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes;(4)influencing factors for prognosis of patients.Measurement data with normal distribution were represented as Mean±SD,and compari-son between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test.Repeated measurement data were analyzed using the repeated ANOVA.Spearman correlation analysis was used for correlation analyses.The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis.Results(1)Patients conditions after being treatment with open abdomen technique.In

关 键 词：胰腺炎 急性 腹腔间隙综合征 腹腔开放 高位肠瘘 急性胃肠损伤 持续时间 

分 类 号：R576[医药卫生—消化系统]