重症急性胰腺炎并发急性肺损伤的临床分析

Severe Acute Pancreatitis Complicated by Acute Lung Injury

目的观察重症急性胰腺炎(SAP)并发急性肺损伤(ALI)患者的发病及住院情况,对可能影响其预后的危险因素进行分析。方法回顾性收集我院2000—2007年SAP住院患者188例,Logistic回归对影响并发ALI患者病死率的危险因素进行分析。结果188例SAP患者并发ALI者70例,其中男62例,女8例;ALI患者死亡19例,病死率为27.1%,与病死率有关的因素有:年龄、原有疾病数≥4、RANSON评分≥3分、器官衰竭数目≥2、A-PACHEⅡ评分≥16分、机械通气(MV)治疗、SEPSIS、腹腔感染、菌血症和手术治疗(P<0.05);PaO2/FiO2≤100mmHg、发病24h内FiO2>60%、肺部感染和血液净化与患者预后无关(P>0.05)。结论ALI是SAP常见并发症,与预后有关的因素是年龄、原有疾病数≥4,RANSON评分≥3分、APACHEⅡ评分≥16分、器官衰竭数目≥2、MV治疗、SEPSIS、腹腔感染、菌血症和手术治疗。

Objective To survey the onset and clinical characteristics of severe acute pancreatitis （SAP） that is complicated by acute lung injury （ALI） , and to analyze the risk factors that may influence its prognosis. Methods Totally 188 SAP patients admitted to our hospital during the year 2000 to 2007 were retrospectively collected. Logstic regression was used to analyze the risk factors that may influence the mortality of ALI complication. Results There in the 188 SAP patients were 70 cases complicated by ALI, with 62 males and 8 females. There were 19 cases of the ALI patients who died, with a mortality of 2% 1%. The mortality -relative factors were age, the number of fundamental diseases≥4, RANSON score≥3, the number of organ failure≥2, APACHE Ⅱ score 〉≥16 , MV therapy, sepsis, abdominal infection and surgical operation （ P 〈0. 05）. however PaO2/FiO2 ≤ 100mmHg, FiO2 within 24h after onset 〉 60% , pulmonary infection and blood purification were not correlated with the prognosis of the patients （ P 〉 0. 05 ）. Conclusion ALI is a common complication of SAP, the correlated factors are age, the number of fundamental diseases≥14, RANSON score ≥3, APACHE Ⅱ score ≥ 16, the number of organ failure≥2, MV therapy, sepsis, abdominal infection and surgical operation.