重症急性胰腺炎治愈出院患者长期生存质量现状调查及影响因素分析  

Current situation investigation and analysis of influencing factors on the long-term quality of life of cured and discharged patients with severe acute pancreatitis

作　　者：周文君 张频捷[1] 余维丽 鹿中华[1] 黎命娟 曹利军[1] 付路 王少康 孙昀[1] Zhou Wenjun;Zhang Pinjie;Yu Weili;Lu Zhonghua;Li Mingjuan;Cao Lijun;Fu Lu;Wang Shaokang;Sun Yun(The First Department of Critical Care Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui,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230000

出　　处：《中华危重病急救医学》2025年第2期146-152,共7页Chinese Critical Care Medicine

基　　金：安徽省高校自然科学研究重大项目(2024AH040107)。

摘　　要：目的调查重症急性胰腺炎(SAP)治愈出院患者长期生存质量的现状,并分析SAP治愈患者出院后生存质量的影响因素。方法回顾性纳入2017年1月至2023年12月入住安徽医科大学第二附属医院重症医科一科接受规范治疗后治愈出院的SAP患者。根据36项简明健康状况调查量表(SF-36)得分将患者分为高分组(生存质量高,SF-36总分前50%的患者)和低分组(生活质量低,SF-36总分后50%的患者),通过调阅病历获得患者的性别、年龄、高血压和糖尿病病史、胰腺炎病因分类、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、严重指数(CTSI)评分,入院时C-反应蛋白(CRP)、降钙素原(PCT)、血糖及三酰甘油等实验室指标,住院期间血管活性药物、无创/高流量通气、有创通气、腹膜后穿刺置管引流、开放式胰腺手术治疗及继发感染等指标,以及出院时仍留置腹腔引流管等相关资料。通过微信、问卷星程序发放随访问卷或电话随访调查患者出院后胰腺内外分泌功能、慢性腹痛等症状发生情况、胰腺炎复发等信息。采用多因素Logistic回归法分析影响SAP治愈出院患者长期生存质量的相关因素。结果最终获得完整病例资料并纳入随访研究的患者共计86例,高分组和低分组患者均为43例。86例患者中,20例患者复发胰腺炎,复发率为23.26%;22例患者(25.58%)出院后发生慢性腹痛,其中5例(5.81%)需服用药物缓解疼痛;33例患者(38.37%)出院后存在胰腺外分泌功能损害,表现为腹胀或腹泻;22例患者(25.58%)胰腺内分泌功能损害,确诊新发糖尿病。单因素分析显示,与高分组相比,低分组高血压史、合并肾功能不全、严重代谢性酸中毒、入院时血钙<2.0 mmol/L、血糖>11.1 mmol/L、治疗期间(血/体液/胰腺坏死组织标本)培养出革兰阳性菌的患者比例更高(48.84%比16.28%,60.47%比32.56%,18.60%比4.65%,88.37%比62.79%,55.81%比30.2Objective To investigate the current status of long-term quality of life in patients with severe acute pancreatitis(SAP)who have been cured and discharged,and to analyze the influencing factors affecting long-term quality of life in SAP cured patients after discharge.Methods A retrospective collection was conducted.Patients who were received standardized treatment before being cured and discharged from the hospital admitted to the first department of critical care medcine of the Second Affiliated Hospital of Anhui Medical University from January 2017 to December 2023 were enrolled.According to the 36-item short form health survey scale(SF-36)score,patients were divided into high score group(high quality of life,the top 50%of patients with total SF-36 score)and low score group(low quality of life,the bottom 50%of patients with total SF-36 score).The gender,age,history of hypertension and diabetes,etiology of pancreatitis,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),sequential organ failure assessment(SOFA),CT severity index(CTSI),laboratory indicators such as C-reactive protein(CRP),procalcitonin(PCT),blood glucose,and triglycerides upon admission,use of vasoactive drugs,non-invasive/high-flow ventilation,invasive ventilation,retroperitoneal puncture and drainage,open pancreatic surgery treatment and secondary infection during hospitalization were collected,as well as the retention of abdominal drainage tubes at discharge from hospital.Distribute follow-up questionnaires or telephone follow-up surveys through WeChat and Question Star programs to investigate the pancreatic secretion function,chronic abdominal pain,and recurrence of pancreatitis of patients after discharge.Multivariable Logistic regression was used to analyze the relevant factors affecting the long-term quality of life of cured patients with SAP.Results A total of 86 patients were ultimately enrolled.There were 43 patients in both the high and low score groups.Among 86 patients,20 experienced acute pancreatitis recurrence,with a rec

关 键 词：重症急性胰腺炎 长期生存质量 影响因素 SF-36健康调查量表 随访 

分 类 号：R576[医药卫生—消化系统]