重症急性胰腺炎并发急性呼吸窘迫综合征发病特点、死亡因素分析及风险评估模型的建立  

Severe acute pancreatitis complicated with acute respiratory distress syndrome:characteristics,death factors and the establishment of risk assessment model

作　　者：黄文炼 刘鸿雁[1] 祝瑞 唐飞 唐瑜[1] 尚娟[1] HUANG Wenlian;LIU Hongyan;ZHU Rui;TANG Fei;TANG Yu;SHANG Juan(Department of Critical Care Medicine,Second Clinical Medical College of North Sichuan Medical College/Nanchong Central Hospital,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院第二临床医学院、南充市中心医院重症医学科,四川南充637000

出　　处：《安徽医药》2022年第6期1187-1192,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)发病特点、死亡因素分析及风险评估模型的建立。方法选择2015年3月至2018年9月南充市中心医院收治的310例SAP病人并发ARDS病人,分成死亡组和存活组,单因素分析两组病人的基线资料,对差异有统计学意义的因素进行非条件logistic多因素回归分析,分析死亡因素并建立风险评估模型。结果310例SAP并发ARDS病人中307例病人均以腹痛为临床起始症状,疼痛多突然发作,部位多集中于中上腹部,且多合并肝功能异常、胰性胸水和心律失常等并发症。两组病人在年龄、饮酒史、合并感染、白蛋白、血肌酐、降钙素原、空腹血糖、24 h急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、急性胰腺炎严重程度床边指数(BISAP)评分及改良的CT严重指数(MCTSI)评分等方面差异有统计学意义(P<0.05)。logistic回归分析表明年龄(≥60岁)[OR=1.725,95%CI:(1.114,2.670)]、饮酒[OR=1.296,95%CI:(1.069,1.570)]、合并感染[OR=3.102,95%CI:(1.716,5.606)]、白蛋白(<35 g/L)[OR=1.923,95%CI:(1.025,3.608)]、24 h APACHEⅡ评分(>11分)[OR=2.782,95%CI:(2.029,3.814)]、BISAP评分(>3分)[OR=2.713,95%CI:(1.822,4.039)]和空腹血糖(>12.0 mmol/L)[OR=2.846,95%CI:(2.335,3.469)]是发生死亡的独立危险因素(P<0.05),预测方程logit(P)=−0.665+0.545X_(年龄)+0.259X_(饮酒)+1.132X_(感染)+0.654X_(白蛋白)+1.023X_(APACHEⅡ评分)+0.998X_(BISAP评分)+1.046X_(空腹血糖)。结论突发性的中上腹腹痛伴发热及消化道症状是SAP并发ARDS病人的发病特点,年龄、饮酒、合并感染、白蛋白、BISAP评分、24 h APACHEⅡ评分和空腹血糖是SAP并发ADRS病人死亡的独立影响因素,建立的模型可进行合理地风险评估。Objective To explore the characteristics of severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS),analyze death factors and establish risk assessment model.Methods Three hundred and ten SAP patients complicated with ARDS,who were treated in Nanchong Central Hospital from March 2015 to September 2018,were assigned into death group and survival group.The baseline data of the two groups received single factor analysis,and the factors with statistically significant difference received non-conditional logistic multifactor regression analysis.Risk factors of SAP patients were explored and risk assessment model was established.Results Among the 310 SAP combined ARDS patients,307 patients had abdominal pain as the initial symptom,which attacks suddenly on most occasions and occurs mostly in the middle and upper abdomen.Most of the patients were complicated with liver function abnormalities,pancreatic hydrothorax and arrhythmia.There were significant differences in age,drinking history,co-infection,albumin(ALB),serum creatinine(SCr),procaicltonin(PCT),fasting blood glucose(FBG),24 h APACHEⅡ(acute physiology and chronic health evaluationⅡ)score,BISAP(bedside index of severity in acute pancreatitis)score and MCTSI(modified CT severity index)score between the two groups(P<0.05).Logistic regression analysis results showed that age(≥60 years old)[OR=1.725,95%CI:(1.114,2.670)],drinking[OR=1.296,95%CI:(1.069,1.570)],co-infection[OR=3.102,95%CI:(1.716,5.606)],ALB(<35 g/L)[OR=1.923,95%CI:(1.025,3.608)],24 h APACHEⅡscore(>11 points)[OR=2.782,95%CI:(2.029,3.814)],BISAP score(>3 points)[OR=2.713,95%CI:(1.822,4.039)]and fasting blood glucose(>12.0 mmol/L)[OR=2.846,95%CI:(2.335,3.469)]were independent risk factors for death(P<0.05).The predictive equation is as follows:logit(P)=−0.665+0.545X_(age)+0.259X_(drinking)+1.132X_(co-infection)+0.654X_(ALB)+1.023X_(APACHEⅡscore)+0.998X_(BISAP score)+1.046X_(FBG).Conclusions Sudden middle and upper abdominal pain with fever and gastrointestinal sym

关 键 词：胰腺炎 急性坏死性 呼吸窘迫综合征 成人 腹痛 血糖 白蛋白类 发病特点 死亡因素分析 风险评估模型 

分 类 号：R576[医药卫生—消化系统] R563.8[医药卫生—内科学]