重症急性胰腺炎患者入院24小时后新发急性呼吸窘迫综合征的危险因素分析

Analysis of risk factors of new acute respiratory distress syndrome in patients with severe acute pancreatitis after 24 hours of admission

目的探讨重症急性胰腺(SAP)患者入院24 h后新发急性呼吸窘迫综合征(ARDS)的危险因素。方法根据入院24 h后是否新发ARDS,将160例SAP患者分为NA-SAP组(未发生ARDS)80例和A-SAP组(发生ARDS)80例,比较两组患者的临床资料。采用logistic回归分析评估SAP患者入院24 h后新发ARDS的影响因素。采用受试者工作特征(ROC)曲线评价各指标对SAP患者入院24 h后新发ARDS的预测价值。结果A-SAP组患者肠内营养开始时间晚于NA-SAP组,入院24 h全身炎症反应综合征(SIRS)患者比例、输液量、APACHE-Ⅱ评分、BISAP评分、MCTSI评分、C反应蛋白(CRP)、中性粒细胞计数均高于NA-SAP组,两组患者入院24 h输液量晶胶比、白蛋白构成比比较差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,肠内营养开始时间及入院24 h BISAP评分、CRP、输液量均为SAP患者入院24 h后新发ARDS的独立危险因素(P<0.05)。ROC曲线分析结果显示,肠内营养开始时间及入院24 h BISAP评分、CRP、输液量预测SAP患者入院24 h后新发ARDS的曲线下面积分别为0.778、0.742、0.715、0.717(P均<0.05)。结论肠内营养开始时间及入院24 h BISAP评分、CRP、输液量为SAP患者入院24 h后新发ARDS的独立危险因素,且上述指标预测SAP入院24 h后新发ADRS具有一定准确性。

Objective To explore the risk factors of new acute respiratory distress syndrome(ARDS)in patients with severe acute pancreas(SAP)after 24 h of admission.Methods According to whether new ARDS occurred after 24 h of admission,160 patients with SAP were divided into NA-SAP group(without ARDS,80 cases)and A-SAPgroup(with ARDS,80 cases).Clinical data between the two groups were compared.Multivariate logistic regression analysis was used to evaluate the influencing factors of new ARDS in patients with SAP after 24 h of admission.Receiver operating characteristic(ROC)curve was used to evaluate predictive value of each index to new ARDS of patients with SAP after 24 h of admission.Results Starting time of enteral nutrition in A-SAP group was later than that in NA-SAP group,proportion of patients with systemic inflammatory response syndrome(SIRS),infusion volume,APACHEⅡscore,BISAP score,MCTSI score,C-reactive protein(CRP)and neutrophil count 24 h after admission in A-SAP group were significantly higher than those in NA-SAP group,there were significant differences of composition ratio of crystal-glue ratio with infusion volume 24 h after admission and albumin between the two groups(P<0.05).Multivariate logistic regression analysis showed that onset time of enteral nutrition,BISAP score,CRP and infusion volume 24 h after admission were independent risk factors of new ARDS in patients with SAP after 24 h of admission(P<0.05).ROC curve analysis showed that area under curve of onset time of enteral nutrition,BISAP score,CRP and infusion volume 24 h after admission predicting new ARDS of patients with SAP after 24 h of admission were 0.778,0.742,0.715 and 0.717 respectively(P<0.05).Conclusion Onset time of enteral nutrition,BISAP score,CRP and infusion volume 24 h after admission are independent risk factors of new ARDS in patients with SAP after 24 h of admission,and above indexes are accurate in predicting new ADRS in patients with SAP after 24 h of admission.