重症急性胰腺炎早期并发多脏器功能障碍综合征的危险因素分析

The risk factors of severe acute pancreatitis complicated with multiple organ dysfunction syndrome(MODS)in the early stage

目的探索重症急性胰腺炎(SAP)患者早期并发多脏器功能障碍综合征(MODS)的临床危险因素。方法回顾性分析1995年1月至1999年12月及2000年1月至2005年6月分别收治的SAP患者107例及113例,前者为A组,后者为B组。对年龄、性别、Ranson评分、APACHEⅡ评分、CT评分以及是否伴有胆道梗阻、休克、高脂血症、腹腔室隔综合征、低氧血症、肺部感染、胸腔积液等因素进行多因素Logistic分析。同时也分析不同临床处理方式对SAP病死率的影响。结果A组(n=107)和B组(n=113)中分别有25例和28例SAP患者早期并发MODS,MODS组和无MODS组两组比较,在Ranson评分,APACHEⅡ评分,CT评分方面差异有显著性(P<0.05)。MODS组在存在休克、胆道梗阻、高脂血症、肺部感染、低氧血症、腹腔室隔综合征、胸腔积液方面高于无MODS组,两组比较,差异有极显著性(P<0.01)。B组患者由于采用了综合性救治技术(如床边血滤,人工肝支持等),其病死率下降与A组比较,差异有显著性(P<0.05)。结论SAP患者早期并发MODS的临床危险因素与休克、胆道梗阻、高脂血症、肺部感染、低氧血症、腹腔室隔综合征、胸腔积液以及临床处理方式有关。而及时有效的治疗可大大降低MODS的发生率。

Objective To study the risk factors of severe acute pancreatitis （SAP） complicated with MODS at the early stage. Methods One hundred and seven SAP patients served as A group, who admitted from Janurary 1995 to December 1999. One hundred and thirty patients served as B group who admilted from Janurary 2000 to 2005. Age, sex, Ranson＇ score, APACHE Ⅱ , CT score, biliary tract obstruction, hypoxia, lung infection, shock, abdomen compartment syndrome, hyperlipemia, pleural effusion, and mortality were analyzed. Results Twenty-five in the A group and 28 in B group two were complicated with MODS at the early stage. There existed difference in Ranson＇s score, APACHE Ⅱ , CT score between patients with and without MODS （ P 〈 0.05 ）. Shock, biliary tract obstruction, abdomen compartment syndrome , hyperlipemia, pleural effusion were more severe in patients with MODS （ P 〈 0.01 ）. Mortality in B group was decreased because of receiving such therapy as bedside CBP, artificial liver support. Conclusion Biliary tract obstruction, hypoxia, lung infection, shock, abdomen compartment syndrome, hyperlipemia, pleural effusion and clinical treatments are connected with SAP complicated with MODS at the early stage. The incidence rate of MODS can be reduced by effective treatment.