重症急性胆管炎患者的死亡风险因素分析

Analysis of mortality risk factors for acute cholangitis of severse type

目的探讨重症急性胆管炎(ACST)患者的死亡风险因素,为临床及时诊治提供依据。方法回顾性分析天津市南开医院微创外科中心2011年6月1日～2012年1月1日收治的61例ACST患者的一般资料、治疗方法及病情变化等,采用Wilcoxon秩和检验、Pearsonχ2检验对患者预后进行12个相关单因素分析,采用二分类Lo-gistic线性回归行死亡风险多因素分析。结果 61例ACST患者中9例死亡。单因素分析显示,白细胞计数、中性粒细胞百分比升高、血小板减少、休克、呼吸衰竭、意识障碍是ACST患者的死亡危险因素;多因素分析显示,影响ACST患者预后因素的强度按风险系数排列依次为意识障碍、休克、血小板计数≤75×109/L、呼吸衰竭、中性粒细胞百分比>90%。结论意识障碍、休克、血小板计数≤75×109/L、呼吸衰竭、中性粒细胞百分比>90%是ACST患者的死亡风险因素;急诊鼻胆管引流(ENBD)可作为ACST明确诊断后的首选治疗方法。

Objective To explore the mortality risk factors of the severe acute cholangitis （acute cholangitis of severse type, ACST） and to provide the evidence for clinical therapy. Methods Analyzed retrospectively the general conditions, therapeutic method and clinical changes of 61 patients treated in Nankai Hospital Minimally Invasive Surgery Center of Tianjin during the 1st June 2011 to the 1 st January 2012, the 12 relative factors were analyzed by Wilcoxon rank sum test and Pearson X2 test and followed by multivariate analysis using Logistic regression model for death factors. Results There were nine death cases in 61 patients with ACST. The univariate analysis display that white blood cell count, neutrophil percentage increased, thrombocytopenia, shock, respiratory failure, disturbance of consciousness were ACST patient＇s risk factors from the 12 risk factors, and multivariate analysis from these risk factors showed that the risk coefficient decreased in turn from the disturbance of consciousness, shock, platelet count 〈 75× 10^3/L, respiratory failure, to the percentage of neutrophils 〉 90%. Conclusions The disturbance of consciousness, shock, platelet count 〈 75 × 10^3/L, respiratory failure, percentage of neutrophils 〉 90% are the death factors of ACST patients; Emergency ENBD can be used as the pre- ferred method for the ACST patients.