基于内经脉息比值探索急性胰腺炎的临床特征及结局  

Explore of clinical characteristics and outcomes of acute pancreatitis based on Neijing pulse-respiration ratio

作　　者：石佳华 李兰[1] 朱萍 夏庆[1] 金涛[1] SHI Jia-hua;LI Lan;ZHU Ping(West China Centre of Excellence for Pancreatitis,Institute of Integrated Traditional Chinese and Western Medicine,West China Hospital of Sichuan University,Chengdu(610041),China)

机构地区：[1]四川大学华西医院中西医结合中心/胰腺炎中心,成都610041

出　　处：《中国中西医结合外科杂志》2023年第2期145-149,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：四川省重大疾病中医药、中西医结合临床循证评价研究项目(2020ZD004)。

摘　　要：目的:基于脉息比值对急性胰腺炎(AP)患者进行亚组分析,比较不同亚组的临床结局,为探索AP的临床亚型提供依据。方法:回顾性分析四川大学华西医院胰腺炎中心临床数据库中2016年1月—2018年1月入院的1636例AP患者,根据脉息比值将患者分为少气(<4)组350例、平人(4~5)组1054例和脉躁(>5)组232例,比较不同亚组的临床结局。结果:脉躁组的局部并发症、持续性器官功能衰竭发生率、感染性坏死发生率及住院时间高于少气组和平人组,差异有统计学意义(P<0.05);重症急性胰腺炎(SAP)患者中,脉躁组的循环衰竭发生率和有创机械通气支持率高于平人组(P<0.05);需要正性肌力药、感染性坏死发生率和手术率显著高于少气组与平人组,差异有统计学意义(P<0.05)。与平人组相比,AP患者中脉躁组发生局部并发症(OR=2.35,95%CI=1.76~3.14,P<0.001)、急性胰周液体积聚(OR=2.29,95%CI=1.71~3.06,P<0.001)、急性坏死性积聚(OR=1.82,95%CI=1.22~2.71,P=0.003)、一过性器官衰竭(OR=2.34,95%CI=1.66~3.30,P<0.001)和手术干预的风险显著增加(OR=2.39,95%CI=1.33~4.27,P=0.003);少气组POF的发生风险明显增加(OR=1.42,95%CI=1.03~1.96,P=0.033)。结论:AP患者根据内经脉息比值可分为少气、平人和脉躁三组,其中脉躁组患者的临床结局最差。Objective In this study,subgroups of patients with acute pancreatitis(AP)were analyzed based on pulse-respiration ratio,and the clinical outcomes of different subgroups were compared,providing bases for further exploring clinical subtypes of AP.Methods The data of 1636 patients with AP from prospective AP database admitted to West China Hospital of Sichuan University between January 2016 and January 2018 were analyzed.According to the pulse-respiratory ratio,the patients were divided into deficiency of qi(<4,350 cases),normal(4-5,1054 cases)and pulse dysphoria(>5,232 cases),and clinical outcomes of different subgroups were compared.Results In overall AP patients,the incidence of local complications,persistent organ failure,infectious pancreatic necrosis and length of hospital stay in the pulse dysphoria group were higher than the group of deficiency of qi and normal group.And the difference was statistically significant between the pulse dysphoria group and the normal group(P<0.05).In SAP patients,the incidence of circulatory failure and rate of invasive mechanical ventilation in the pulse dysphoria group were significantly higher than those in normal group(P<0.05).And the incidence of inotropes usage,infectious pancreatic necrosis and the rate of operation were significantly higher than those in the group of deficiency of qi and the normal group.The difference was statistically significant(P<0.05).The pulse dysphoria group in AP patients showed an increased risk of local complications(OR=2.35,95%CI=1.76-3.14,P<0.001),acute peripancreatic fluid collection(OR=2.29,95%CI=1.71-3.06,P<0.001),acute necrotic collections(OR=1.82,95%CI=1.22-2.71,P=0.003),persistent organ failure(OR=2.34,95%CI=1.66-3.30,P<0.001)and surgery(OR=2.39,95%CI=1.33-4.27,P=0.003)when compared with the normal group.The group of deficiency of qi also showed an increased risk of persistent organ failure(OR=1.42,95%CI=1.03-1.96,P=0.033).Conclusion AP patients were divided into deficiency of qi,normal and pulse dysphoria according to the Neijing pulse

关 键 词：脉息比值 急性胰腺炎 脉搏 呼吸频率 

分 类 号：R576[医药卫生—消化系统]