重症急性胰腺炎并发结肠瘘愈合患者非手术愈合的相关因素分析  

Analysis of related factors of non-surgical healing in patients with severe acute pancreatitis complicated by colon fistula healing

作　　者：陈法喜 许尧 姜方方 凤鸣 张敬柱[2] 童智慧[2] 李百强[2] 李维勤[2] CHEN Fa-xi;XU Yao;JIANG Fang-fang;FENG Ming;ZHANG Jing-zhu;TONG Zhi-hui;LI Bai-qiang;LI Wei-qin(Department of Pancreatitis Diagnosis and Treatment Center.The Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China;Department of Intensive Care Medicine,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)胰腺炎诊疗中心,南京210000 [2]东部战区总医院(原南京军区南京总医院)重症医学科,南京210002

出　　处：《医学研究生学报》2022年第9期938-944,共7页Journal of Medical Postgraduates

基　　金：国家自然科学基金(82070669);江苏省自然科学基金(BK20211135)。

摘　　要：目的 目前关于重症急性胰腺炎(SAP)并发结肠瘘愈合患者非手术愈合的影响因素相关研究较少。文中旨在探讨影响SAP并发结肠瘘愈合患者非手术愈合的相关因素。方法 选取2013年1月1日至2020年12月31日东部战区总医院重症医学科收治的144例SAP并发结肠瘘愈合患者。通过对性别、年龄、病因、器官功能衰竭、基础疾病、胰腺周围坏死组织感染(IPN)的处理方式、营养状况、营养支持方式、持续性炎症反应-免疫抑制-分解代谢综合征(PICS)等因素进行分析,采用Logistics回归模型探究影响SAP并发结肠瘘患者非手术愈合的相关因素。结果 144例SAP并发结肠瘘愈合患者中77例患者非手术愈合,67例患者为手术愈合,非手术愈合率为53.5%。多因素Logistic回归模型显示,糖尿病(OR=0.158,95%CI:0.031~0.797)、IPN手术处理(OR=0.232,95%CI:0.070~0.772)、发现结肠瘘后应用肠外营养(OR=0.233,95%CI:0.072~0.756)、结肠瘘后新发器官功能衰竭(OR=0.231,95%CI:0.063~0.842)、PICS(OR=0.067,95%CI:0.017~0.267)为SAP并发结肠瘘患者非手术愈合的相关因素(P<0.05)。结论 SAP并发结肠瘘非手术治疗愈合率高,但应注意糖尿病、IPN开腹手术、结肠瘘后新发器官衰竭及应用肠外营养、PICS等影响SAP合并结肠瘘非手术愈合的危险因素。Objective At present, there are few related researches on influence factors of non-surgical healing in patients with severe acute pancreatitis(SAP) complicated by colon fistula healing. This paper aims to explore the factors that affect the non-surgical healing of patients with SAP complicated by colon fistula. Methods A retrospective study was performed on 144 patients with SAP complicated by colon fistula healing who were admitted to our center from January 1, 2013 to December 31, 2020. The gender, age, etiology, organ failure, underlying diseases, and infected pancreatic necrosis(IPN) treatment, nutritional status, nutritional support, persistent inflammation immune-suppression catabolism syndrome(PICS) and other factors were analyzed, and the logistic regression model was used to explore factors affecting non-surgical healing in patients with SAP complicated by colic fistula. Results Among 144 patients with SAP complicated by colon fistula healing, 77 were healed by non-surgical methods and 67 were healed by surgery, and the non-surgical healing rate was 53.5%. Multivariate logistic regression model showed that diabetes(OR=0.158, 95% CI: 0.031~0.797), IPN surgical treatment(OR=0.232, 95% CI: 0.070~0.772), parenteral nutrition after finding colon fistula(OR=0.233, 95% CI: 0.072~0.756), new organ failure after colon fistula(OR=0.231, 95% CI: 0.063~0.842) PICS(OR=0.067, 95% CI: 0.017~0.267) was the related factor of non-surgical healing in patients with SAP complicated with colon fistula(P<0.05). Parenteral nutrition and PICS were the related factors affecting non-surgical healing in patients with SAP complicated by colon fistula. Conclusion The non-surgical healing rate of severe acute pancreatitis complicated with colon fistula is high, but attention should be paid to the risk factors affecting the healing of SAP complicated by colon fistula, diabetes, IPN laparotomy, new organ failure after colon fistula and parenteral nutrition, PICS, etc.

关 键 词：重症急性胰腺炎 胰腺坏死组织感染 结肠瘘 非手术愈合 

分 类 号：R576[医药卫生—消化系统]