重症急性胰腺炎患者胰周引流时机对预后的影响:一项双中心临床回顾性研究  

Effect of the timing of peripancreatic fluid drainage on prognosis in patients with severe acute pancreatitis:a two-center clinical retrospective study

作　　者：何宇敏 王晓萍[1] 邵菲[2] 唐子人[2] 赵燊 He Yumin;Wang Xiaoping;Shao Fei;Tang Ziren;Zhao Shen(Department of Emergency,Fujian Provincial Hospital,Fujian Provincial Clinical Medical College,Fujian Medical University,Fuzhou 350001,China;Department of Emergency,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100700,China;Department of Intensive Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]福建省立医院急诊科,福建医科大学省立临床医学院,福州350001 [2]首都医科大学附属北京朝阳医院急诊科,北京100700 [3]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《中华急诊医学杂志》2022年第6期822-827,共6页Chinese Journal of Emergency Medicine

基　　金：福建省自然科学基金(2020J05263)。

摘　　要：目的评价胰周引流时机对重症急性胰腺炎(severe acute pancreatitis,SAP)患者生存结局的影响。方法回顾性研究纳入2015年1月至2019年12月收治的2家三甲医院的271例SAP患者。记录APACHE Ⅱ评分,SOFA评分,CT分级,胰周引流情况和患者的生存结局。患者分为早期和非早期胰周引流组(EPCD和non-EPCD)。使用Cox比例风险模型对数据进行倾向评分匹配(propensity score matching,PSM)和分层分析。结果PSM后,EPCD组与non-EPCD组30 d和90 d死亡风险差异有统计学意义,分别为0.134[95%CI:0.029-0.576(P=0.007)]和0.166[95%.CI:0.044-0.631(P=0.008)]。分层分析提示,当SOFA评分为≥4或APACHE Ⅱ评分为≥8时,EPCD组和non-EPCD组的30d和90d死亡风险差异有统计学意义。结论SOFA评分≥4分或APACHE Ⅱ评分≥8分的急性重症胰腺炎患者,早期胰周引流可降低死亡风险,CT分级对急性重症胰腺炎患者胰周引流时机的决策帮助不大。Objective To evaluate the effect of the timing of peripancreatic drainage on the survival outcome of patients with severe acute pancreatitis(SAP).Methods This retrospective study included 271 patients with SAP admitted to two tertiary hospitals from January 2015 to December 2019.The Acute Physiology and Chronic Health EvaluationⅡscore(APACHEⅡ),Sequential Organ Failure Assessment score(SOFA),computed tomography(CT)grade,peripancreatic drainage situations,and survival outcome of patients were recorded.Patients were divided into the early and non-early peripancreatic catheter drainage groups(EPCD and non-EPCD).The data were analyzed using the Cox proportional hazard model for propensity score matching(PSM)and stratification.Results After PSM,the 30-day and 90-day risk of death between the EPCD and non-EPCD groups were significantly different(0.134,95%CI:0.029-0.576,P=0.007;0.166,95%CI:0.044-0.631,P=0.008,respectively).Furthermore,stratified analysis revealed significant differences in 30-day and 90-day risk of death between the EPCD and non-EPCD groups when the SOFA score was≥4 or the APACHE Ⅱ score was≥8.Conclusions For patients with SAP with SOFA score≥4 or APACHE Ⅱ score≥8,early peripancreatic drainage can reduce the risk of death,but CT grading is not helpful for the decision-making of drainage timing in patients with SAP.

关 键 词：急性重症胰腺炎 胰周引流 SOFA评分 APACHEⅡ评分 倾向性评分匹配 生存分析 

分 类 号：R576[医药卫生—消化系统]