急性胰腺炎入住方式对腹膜后感染及预后的影响  

Effect of admission mode of acute pancreatitis patients on retroperitoneal infection and prognosis

作　　者：曹利军[1] 付路 杨翔[1] 张频捷[1] 鹿中华[1] 陈虎[1] 李嘉慧 孙昀[1] Cao Lijun;Fu Lu;Yang Xiang;Zhang Pinjie;Lu Zhonghua;Chen Hu;Li Jiahui;Sun Yun(The First Department of Critical Care Medicine,the Second Hospital of Anhui Medical University,Hefei 230601,China;The Second Clinical College of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院重症医学一科,合肥230601 [2]安徽医科大学第二临床学院,合肥230601

出　　处：《中华急诊医学杂志》2023年第10期1328-1332,共5页Chinese Journal of Emergency Medicine

基　　金：安徽医科大学第二附属医院临床研究培育计划项目(2020LCZD08)。

摘　　要：目的探讨急性胰腺炎患者入住重症监护病房(ICU)方式对并发腹膜后感染及预后的影响。方法回顾性分析2013年1月至2022年7月本院ICU收治的急性胰腺炎患者的临床资料, 根据入住ICU的方式将患者分为急诊组(首诊入ICU及从相关科室急诊转入)和延迟组(因病情演变由普通病房转入);根据是否并发腹膜后感染将患者分为感染组和非感染组。收集患者的性别、年龄、基础疾病、实验室检查指标、急性生理学与慢性健康状况评分Ⅱ( APACHE Ⅱ )、序贯器官衰竭评分(SOFA)、急性胰腺炎CT严重程度指数评分(CTSI)、急性胰腺炎严重程度床边指数(BISAP)评分及并发症发生情况;记录患者腹膜后感染发生率、30 d病死率和ICU住院时间及总住院时间。应用单因素和多因素Logistic回归分析急性胰腺炎患者并发腹膜后感染的危险因素。结果共纳入271例急性胰腺炎患者, 其中急诊组95例, 延迟组176例;感染组71例, 非感染组200例。延迟组患者入住ICU后腹膜后感染发生率以及30d病死率均明显高于急诊组[腹膜后感染发生率:31.82% (56/176)vs. 15.79%(15/95);30 d病死率:13.64%(24/176)vs. 4.21%(4/95), 均P<0.05], ICU住院时间(d) [(15.4±21.3)vs. (8.6±10.8), P <0.05]及总住院时间(d) [(33.3±29.4)vs. (23.9±18.9), P <0.05]也较急诊组明显延长。单因素分析显示, 感染组与非感染组的糖尿病、APACHE-Ⅱ评分、SOFA评分、CTSI评分, BISAP评分, 尿素氮、肌酐、血钙、D-D二聚体、腹腔穿刺引流及病情演变由普通病房转入ICU等比较差异均有统计学意义。多因素Logistic回归分析显示, 糖尿病、SOFA评分, CTSI评分及腹腔穿刺置管引流及因病情恶化转入ICU等是胰腺炎患者发生腹膜后感染的独立危险因素(优势比分别为3.379, 1.150, 1.358, 3.855, 2.285)。结论因病情演变延迟转入ICU的急性胰腺炎患者更容易发生腹膜后感染, ICU住院时间更长, 病死率更高;延迟入住Objective To explore the relevance between secondary retroperitoneal infection,as well as the outcomes,and the approach of intensive care unit(ICU)admission for the patients suffered from acute pancreatitis.Methods Patients with acute pancreatitis admitted to the ICU of the Second Affiliated Hospital of Anhui Medical University from January 2013 to July 2022 were retrospectively analyzed.According to ICU admission approaches,the patients were divided into the emergency group(first admission or transferred from the emergency department)and the delayed group(transferred from the general wards due to disease evolution).Patients were also divided into retroperitoneal infection group and non-retroperitoneal infection group according to whether retroperitoneal infection was accompanied.Patients'baseline data including gender,age,underlying diseases,laboratory test indicators,acute physiology and chronic health evaluation II score(APACHE II),sequential organ failure assessment(SOFA),computed tomography severity index(CTSI),bedside index of severity in acute pancreatitis(BISAP),and acute complications were collected.Univariate and multivariate logistic regression was used to analyze the risk factors of retroperitoneal infection in patients with acute pancreatitis.Results A total of 271 patients with acute pancreatitis were enrolled,including 95 cases in the emergency group and 176 cases in the delayed group.The cohort included 71 cases with and 200 cases without retroperitoneal infection development.The incidence of retroperitoneal infection and the 30-day mortality of patients in the delayed group,which was observed with a significantly longer ICU stay(days),[(15.4±21.3)vs.(8.6±10.8),P<0.05],were significantly higher than those in the emergency group[retroperitoneal infection incidence rate:31.82%(56/176)vs.15.79%(15/95),30-day mortality:13.64%(24/176)vs.4.21%(4/95),both P<0.05].Univariate Logistic analysis showed significant differences in diabetes,APACHE II,SOFA,CTSI and BISAP score,urea nitrogen,creatinine,blood ca

关 键 词：胰腺炎 腹膜后感染 预后 危险因素 

分 类 号：R576[医药卫生—消化系统]