重症急性胰腺炎早期死亡因素分析

Analysis of reasons for early death of patients with severe acute pancreatitis.

目的探讨与重症急性胰腺炎（SAP）死亡相关的早期危险因素。方法回顾性分析自2001年1月～2005年12月收治的86例SAP患者。根据预后不同将SAP患者分为生存组和死亡组，分别对两组患者入院24h内临床和实验室检查资料进行对比及Logistic回归分析。结果死亡组19例的APACHE Ⅱ评分、24h内尿量、血肌酐、动脉血氧分压、血浆凝血功能及腹水发生率与生存组67例相比较．差异有统计学意义（P〈0．01）．血糖、血三酰甘油、血清白蛋白、血钙、血pH值、入院时呼吸频率、心率及麻痹性肠梗阻发生率差异也有统计学意义（P〈0．05）．而年龄、性别、平均动脉压、血尿淀粉酶、白细胞、红细胞压积、血小板及肝功能无显著差异。经多因素Logistic回归分析显示．腹水、动脉血氧分压、血清白蛋白和SAP死亡相关。结论腹水、动脉血氧分压和血清白蛋白是SAP死亡独立的早期危险因素。

Objective To investigate the risk factors for the early death of patients with severe acute pancreatitis （SAP）. Methods Clinical data of 86 SAP patients, who were referred to our hospital from January 2001 to D ecemher 2005, were analyzed retrospectively. The patients were divided into death group and survival group according to their outcome. The clinical and laboratory data of all patients within 24 hours of admission were analyzed and were subjected to Logistic regression analysis. Results The APACHE 9 score. 24 hour urine volume, serum creatinine, arterial oxygen pressure, coagulation function, and incidences of ascites were significantly different between 19 death cases and 67 survival cases （P 〈 0. 01 ）. Marked differences were also found in blood sugar, plasma triglyceride, serum albumin, serum calcium, arterial pH. breath rate in admission, heart rate, and incidences of paralytic ileus（P〈 0. 05）between the 2groups, but there was no difference in age, gender proportion, mean arterial pressure, blood and urine amylase, white blood cell count, hematocrit, platclet count, and liver function between the 2 groups. Multiple Logistic regression analysis showed that ascites, arterial oxygen pressure, and albumin were associated with early death of SAP patients. Conclusions The independent risk factors related to early mortality of SAP patients include ascites, arterial oxygen pressure, and albumin.