重症急性胰腺炎患者初期合并不同水平高血糖的临床研究

Clinical Study on Different Admission Serum Glucose Levels in Patients with Severe Acute Pancreatitis

目的探讨重症急性胰腺炎（SAP）患者初期（人院时）合并不同水平高血糖的临床特点及其对器官功能衰竭、病死率等相关预后的影响和防治措施。方法2005年8月1日至2007年12月31日收治的SAP合并血糖≥6．1mmol／L患者218例，分为轻度血糖升高组（血糖6．1～11．1mmol／L）115例，中度血糖升高组（血糖11．2～16．7mmol／L）71例和重度血糖升高组（血糖〉16．7mmol／L）32例。比较分析3组患者人院时的各项临床体征、生化指标及Ranson、APACHEⅡ、Balthazar CTSI、胰腺炎结局预测（POP）评分与早期器官衰竭、中转ICU及后期病死率、感染率和中转手术率。结果3组患者入院时脉搏次数、呼吸频率，血乳酸脱氢酶、血尿酸素氨、血肌酐水平，Ranson、APACHEⅡ评分，与72hAPACHElI、CTSI评分依次升高（P〈0．01）；中、重度血糖升高组患者血清Ca2＋浓度低于轻度血糖升高组（P〈O．01）。中、重度高血糖组患者的呼吸、肾脏、心血管系统单一及多器官功能衰竭的发生率高于轻度血糖升高组（P（0．01）。3组患者病程早期随血糖水平升高，其多器官功能衰竭发生率分别是t6．5％、45．1％和50．0％（P〈0．01），中转ICu率分别是10．4％、26．8％和34．4％（P〈0．01）。而三组患者后期病死率、感染率及中转手术率比较，仅后期病死率差异有统计学意义分别为7．8％、16．9％和40．6％（P〈0．01）。结论SAP初期伴高水平血糖可增加患者并发症发生率及病死率，临床治疗应重视监测与控制血糖。

[Abstract] Objective To investigate the clinical characteristics, prognosis effects and management of different admission serum glucose levels in patients with severe acute pancreatitis （SAP）. Methods A retrospective analysis involving a total of 218 patients with SAP and have serum glucose ~6.1 mmol/L at admission during the period from August 1, 2005 to December 31, 2007 was enrolled based on the coding data in West China hospital. They were divided into 3 groups according to admission glucose levels of 6. 1-11. 1 mmol/L （n= 115）, 11. 2- 16.7 mmol/L （n=71）, and ~16.7 mmol/L （n=32） respectively. Patients＇ demographic characteristics, clinical parameters, various scoring systems, the ICU transfer rate during early phase and the mortality, infection rate and operation transfer rate during later phase were obtained and calculated. Results The pulse and respire frequency, the levels of serum lactate dehydrogenase （LDH）, blood urea nitrogen （BUN）, creatinine （Crea） and scores on the Ranson Criteria, Acute Physiology and Chronic Health Evaluation H （APACHE Ⅱ ） at admission, APACHE Ⅱ and Bahhazar＇s Computed Tomography Severity Index （CTSI） within 72 hours increased in sequence according to mild, moderate and severe hyperglycemic group （P〈0.01）. Whereas the concentration of serum Ca2＋ was lower than that in the mild elevated serum glucose group （P〈0.01）. In the 3 groups, the early single organ failure rates were elevated in turn （P〈0.01） and the multi-organ failure rates were 16.5%, 45. 1M and 50.0% （P〈0.01） respectively. Simultaneously, the ICU transfer rates were 10.4%, 26.8% and 34.4%, while the mortality in the 3 groups were 7.8%, 16.9% and 40.6% respectively, which were statistically significant （P%0.01） . Conclusion The findings of the study suggest that admission elevated glucose is an indicator of organ failure and poor prognosis of SAP.