高原重症急性胰腺炎早期相关因素的对比分析

Risk factors and therapeutic strategies for early stage severe acute pancreatitis in plateau

目的探讨高原地区重症急性胰腺炎(SAP)患者的早期相关的危险因素及用以制定相应的治疗策略。方法回顾性对比分析地处高原和平原的两组患者,分别将其设为高原组(63例)和平原组(64例)。通过对两组患者的一般情况、APACHEⅡ评分、是否伴有血液浓缩、休克、低氧血症等合并症,以及早期不同的处理方式等因素对SAP病死率的影响进行Lo-gistic分析。结果高原组SAP患者早期在血液浓缩(HCT>50%)、低氧血症、休克,以及并发多脏器功能障碍综合征(MODS)方面明显高于平原组的患者,差异有显著性(P<0.01)。平原组患者由于后期治疗策略的转变,采用了早期液体足量复苏,早期机械通气,伴腹腔高压者早期行腹腔引流等,其病死率下降,与高原组比较,差异有显著性(P<0.01)。结论高原地区SAP患者早期并发MODS及死亡的危险因素与血液浓缩、休克、低氧血症,以及与临床处理的方式有关。积极纠正低氧血症,液体足量复苏纠正休克和改善血液浓缩,控制炎症反应是阻止SAP早期发生MODS的关键。

Objective To study risk factors and therapeutic strategies for earlystage severe acute pancreatitis （SAP） in plateau. Methods Two groups of patients from plateau and plain separately were studied. Group from plateau consisted of 63 SAP patients, and group from plain consisted of 64 SAP patients. General health condition, acute physiology and chronic healthy score （APACHE Ⅱ ）, hemoconcentration, shock, and hypoxia were analyzed using logistic analysis. Risk factors affecting the fatality rate of SAP in terms of treatment were analyzed. Results In the early stage the conditions were more severe in group from plateau than in group from plain with regard to hemoconcentration （HCT 〉 50% ）, hypoxia, shock, and multiple organ disfurbance syndrome （MODS） and the difference was significant （ P 〈 0.01）. The fatality in group from plain was lower than that in group from plateau because of changes in the therapeutic strategies including sufficient liquid resusci- tation, mechanical ventilation, and abdominal drainage of abdomen compartment syndrome; and the difference was significant （ P 〈 0.01 ）.Conclusions Risk factors affecting high altitude SAP complicated by MODS in the early stage include hemoconcentration, shock, hypoxia and strategy of clinical management. Positive correction of hypoxia, suflqeient fluid resuscitation, improvement of hemoeoneentmtion, and inflammation control are crucial for preventing MODS in early SAP.