老年急性胰腺炎83例发病特点及预后分析

Clinical characteristics and prognostic factors of acute pancreatitis in the elderly

目的:探讨老年急性胰腺炎(AP)的发病特点及预后影响因素。方法:回顾性分析83例老年AP患者临床资料,随机选择同期入院20～50岁AP患者124例作为非老年对照组,比较两组间的病因、临床特点及并发症,对其预后影响因素进行分析。结果:老年AP症状不典型,常见病因为胆源性(75.9%);与非老年AP组相比,老年AP并发症较多,其中感染37.3%、多器官功能障碍(MODS)38.6%、休克30.1%,差异具有显著性。老年AP中21例死亡,病死率25.3%,常见死亡因素为器官功能障碍和感染。Logistic回归显示,感染、肺和肾功能障碍是影响老年AP预后的独立危险因素。结论:老年AP病因以胆源性多见,易并发感染、休克和多器官功能障碍;感染、肺和肾功能障碍是影响老年AP预后的独立危险因素。积极控制感染、防治多器官功能障碍对老年AP的治疗具有重要意义。

Objective： To investigate the clinical characteristics and prognostic factors of acute pancreatitis（AP） in the elderly patients（≥60 years of age）.Methods： We retrospectively reviewed 83 cases of AP in elderly patients and 124 cases of control group which treated in our hospital between 2008 and 2011.Collected data included etiology,clinical characteristics,local complications and systemic complications,as well as prognostic factors.Results： The clinical characteristics of AP in the elderly was not typically as the young.Biliary etiologies was the first causes that accounted for over 75.9% of AP in the elderly,while alcoholic etiologies was the first causes in the young（P0.01）.Compared to the control group,37.3% patients of AP in the elderly developed infection,38.6% developed multiple organ dysfunction syndrome（MODS）,and 30.1%developed shock（P0.05、0.01、0.01）.Of the 83 cases of AP in elderly,21cases died of MODS and infection.By multivariate logistic regression analysis,independent prognostic factors for mortality were infecton,respiratory failure and renal failure.Conclusion： The etiology of AP in the elderly is quite different from that in the young.Biliary etiology is the main causes in the aged.The elderly are more easily to subject infection,shock and MODS.Infecton,respiratory failure and renal failure are independent factors of prognosis of AP in the elderly.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with AP.