急性胰腺炎重度患者并发感染性胰腺坏死的危险因素及转归分析

doi:10.3969/j.issn.1006-6233.2019.07.038

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摘要目的: 研究急性胰腺炎重度患者(SAP)并发感染性胰腺坏死的危险因素并探讨其对患者预后的影响。方法: 回顾性分析我院319例SAP患者临床资料,根据是否发生胰腺感染分为感染组(n=62)和非感染组(n=257),采集两组患者个人基本信息、病因、病程、症状体征、并发症发生情况、实验室检查结果、各器官系统功能评分以及相应治疗措施等临床资料并进行比较分析;随访两组治疗效果,比较两组病情变化及预后情况。结果: 319例SAP患者中并发胰腺感染62例(19.44%),单因素分析结果显示感染组和非感染组病程、低氧血症、MOF、胰腺外感染、WBC、CRP、APACHEⅡ评分、禁食时间、机械通气及抗生素应用情况等因素差异有统计学意义(P<0.05);logistic回归分析结果显示,病程、低氧血症、MOF、胰腺外感染、禁食时间及机械通气为SAP并发胰腺感染的独立危险因素(P<0.05),且抗生素应用为有效保护因素(P<0.05);感染组和非感染组病死率分别为25.81%和4.28%,差异有统计学意义(P<0.05)。结论: SAP并发感染性胰腺坏死可明显增加患者死亡风险,其独立危险因素包括病程、低氧血症、MOF、胰腺外感染、禁食时间及机械通气,保护因素为预防性应用抗生素。

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关键词 ：急性胰腺炎, 胰腺感染, 胰腺坏死, 危险因素, 转归

Abstract：Objective: To study the risk factors of infective pancreatic necrosis in patients with severe acute pancreatitis (SAP) and to explore their effects on prognosis. Methods: The clinical data of 319 patients with SAP in our hospital were retrospectively analyzed. According to whether pancreatic infection occurred, they were divided into infection group (n=62) and non-infection group (n=257). Clinical data of basic information, etiology, disease course, symptoms and signs, occurrence of complications, laboratory results, organ system function score and corresponding treatment measures were collected in the two group and compared and analyzed. The treatment effects of the two groups were followed up, and the condition changes and prognosis were compared between the two groups. Results: Among 319 patients with SAP, 62 cases (19.44%) were complicated with pancreatic infection, and the univariate analysis showed that there were statistically significant differences in the disease course, hypoxemia, MOF, extra-pancreatic infection, WBC, CRP, APACHE II score, fasting time and mechanical ventilation and antibiotic application between infection group and non-infection group (P<0.05). Logistic regression analysis showed that the disease course, hypoxemia, MOF, extra-pancreatic infection, fasting time and mechanical ventilation were independent risk factors for pancreatic infection in SAP (P<0.05), and antibiotic applicationwasan effective protective factor (P<0.05). The case mortality of infection group and non-infection group were 25.81% and 4.28% respectively(P<0.05). Conclusions: SAP complicated with infectiouspancreatic necrosis can significantly increase the mortality risk of patients. And its independent risk factors include disease course, hypoxemia, MOF, extra-pancreatic infection, fasting time and mechanical ventilation, and its protective factor is preventive application of antibiotics.

Key words： Acute pancreatitis Pancreatic infection Pancreatic necrosis Risk factors Outcomes

基金资助:四川省科技厅项目,(编号:2015S20126)

通讯作者: 张铭光

引用本文:

刘燕, 王春晖, 张铭光, 罗斌阳, 何柳, 唐莉, 申明. 急性胰腺炎重度患者并发感染性胰腺坏死的危险因素及转归分析[J]. 河北医学, 2019, 25(7): 1198-1201.
LIU Yan, WANG Chunhui, ZHANG Mingguang, et al. Risk Factors and Outcomes of Infectious Pancreatic Necrosis in Patients with Severe Acute Pancreatitis. HeBei Med, 2019, 25(7): 1198-1201.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2019.07.038 或 http://www.hbyxzzs.cn/CN/Y2019/V25/I7/1198