探讨重症急性胰腺炎与器官功能衰竭之间的关系

Explore the relationship between severe acute pancreatitis and organ failure

目的:研究重症急性胰腺炎患者器官功能衰竭的发病率以及器官功能衰竭与胰腺坏死和感染坏死程度之间的关系。方法:将2003年3月—2011年6月被明确诊断为重症急性胰腺炎的患者纳入本研究。器官功能衰竭的诊断依据是Atlanta标准。感染坏死的诊断是基于标本培养阳性。依据CT扫描情况,胰腺坏死程度被分为<30%,30～50%和>50%。对持续器官功能衰竭患者的资料进行分析,探讨胰腺坏死和感染的程度与持续器官功能衰竭之间的关系。结果:128例重症急性胰腺炎患者,男99例,女29例,平均年龄(42.6±16.1)岁,52.2%(67/128)的患者有器官功能衰竭。在器官功能衰竭患者中,49.3%有1个器官功能衰竭,32.8%有2个器官功能衰竭和17.9%有多器官功能衰竭。肺衰竭是最常见的器官功能障碍(76.1%)。患者年龄的增加和越高的APACHEⅡ评分是器官功能衰竭进展的重要危险因素(P<0.05)。CT扫描显示:1个、2个和3个器官衰竭患者的胰腺坏死超过50%的比例分别为48.5%、59.1%和83.3%,然而,在没有器官功能衰竭的患者中,只有27.9%的患者的胰腺坏死程度超过50%(P<0.001)。没有发现感染坏死与器官功能衰竭之间存在相关性。总体死亡率为47.7%,衰竭的器官越多,死亡率越高(P<0.05)。结论:52.2%的重症急性胰腺炎患者出现器官功能衰竭。器官功能衰竭的发生与年龄的增加、较高的APACHEⅡ评分和胰腺坏死的程度显著相关,与感染坏死之间无显著相关性。

Objective： To investigate the incidence of organ failure in patients with severe acute pancreatitis and the relationship between organ failure and the degree of pancreatic necrosis and infected necrosis. Methods： From 2003 to 2011, patients with severe acute pancreatitis in our hospital were enrolled in this study. Organ failure diagnosis was based on the standard of Atlanta. The diagnosis of infected necrosis was based on the positive culture of specimens. According to the CT scans, the degree of pancreatic necrosis was divided into 〈30%, 300 - 50% and 〉50%. The infor- mation of patients with sustained organ failure was analyzed to explore the relationship between the extent of pancreatic necrosis or infection and sustained organ failure, Results： The study included 128 cases of patients with severe acute pancreatitis, 99 males, 29 females, mean age 42.6 ± 16.1 years, 52.2% of patients with organ failure. Of all the organ failure patients, 4913% had one organ failure, 32.8% had two organ failure and 17.9% multiple organ failure. Lung failure was one of the most common organ dysfunctions （76,1%）. The increase in the age of patient and the higher A- PACHE II score were the important risk factors for organ failure progress. CT scans showed that the degree of pancreatic necrosis in patients with one, two and three failure organs were 48.5%, 59.1% and 83.3%, respectively, however,the extent of pancreatic necrosis in only 28.5% of patients without organ failure was more than 50% （P〈0.001）. no correlation between infected necrosis and organ fail- ure was found. The overall mortality rate was 47.7%, the more of the failure organs, the higher mor- tality rate. Conclusion： Severe acute organ failure occurred in 52.2% of patients with severe acute pancreatitis. The increase of patient＇s age,the higher APACHE II score and the extent of necrosis were associated with organ failure, but no relationship between infected necrosis and organ failure.