急性胰腺炎病程中器官功能衰竭的发生规律

The pattern of organ dysfunction in acute pancreatitis

目的探讨急性胰腺炎病程中出现的脏器功能衰竭的规律。方法回顾性分析瑞金医院2001年1月至2008年12月外科收治的783例重症急性胰腺炎（SAP）患者资料，依据2012版急性胰腺炎分类标准，将原诊断为SAP的患者细分为中度急性胰腺炎（MSAP）和重度急性胰腺炎（SAP）。器官功能衰竭的评判建立在SOFA评分标准的基础上。结果783例患者中MSAP患者573例，SAP患者210例。病因以胆源性为主，占47．9％。治愈698例，病死85例，病死率为10．9％。783例患者中共273例（34．9％）出现器官功能衰竭，其中出现1、2、3个和4个及以上器官功能衰竭的患者分别为109、81、60和23例，病死例数分别为2、30、30和23例，4个及以上器官功能衰竭患者的病死率为100％。出现单个器官功能衰竭的109例中，MSAP48例，SAP61例，98．2％被成功治愈，仅2例病死。出现多器官功能衰竭的164例中，MSAP15例，SAP149例，50．6％的患者病死。发生呼吸系统、心血管系统、神经系统、肾功能、血液系统、肝功能衰竭患者分别为206例次（26．3％）、103例次（13．2％）、92例次（11．7％）、80例次（10．2％）、41例次（5．2％）、27例次（3．4％），病死率分别为38．8％（126／206）、49．5％（51／103）、37．O％（34／92）、63．8％（51／80）、53．7％（22／41）、44．4％（12／27）。呼吸功能衰竭发生率最高，肾功能衰竭病死率最高。结论在AP病程中单个器官功能衰竭发生率最高，但病死率很低，4个及以上器官功能衰竭发生率较低，但病死率高达100％；呼吸系统和心血管系统功能衰竭的发生率最高，肾功能和血液系统功能衰竭的预后最差。

Objective To investigate the pattern of organ dysfunction in acute panereatitis. Methods Seven hundred and eighty-three SAP patients who were treated in Department of Surgery, Ruijin Hospital from January 2001 to December 2008 were retrospectively analyzed. According to 2012 acute pancreatitis classification, these SAP patients were further divided into MSAP and SAP. Diagnosis of organ dysfunction was based on SOFA scores, Results Among the 783 patients, there were 573 MSAP patients and 210 SAP patients. The main etiology was of biliary origin （47.9%）. Six hundred and ninety-eight patients survived, and 85 patients died with the mortality rate of 10.9%. Among the 783 patients, organ dysfunction occurred in 273（34.9% ） patients, and the number of patients with 1, 2, 3, 4 or more organs dysfunction was 109, 81, 60 and 23, and the mortality was 1.8% （2 patients）, 37.0% （30 patients）, 50.0% （30 patients）, 100%. Among the 109 patients with single organ dysfunction, there were 48 MSAP and 61 SAP patients, and 98.2% was cured, only 2 patients died. Among the 164 patients with multiple organ dysfunction, there were 15 MSAP and 149 SAP patients, and 50.6% died. Respiratory, cardiovascular, nervous, renal, hematologic and liverdysfunction occurred in 206 （26.3%）, 103 （13.2%）, 92 （11.7%）, 80 （10.2%）, 41 （5.2%）, 27 （3.4%）; and the mortality rates were 38.8% （126/206）, 49.5% （51/103）, 37.0% （34/92）, 63.8% （51/80）, 53.7 % （22/4）, 44.4% （ 12/27 ）. Respiratory dysfunction had the highest incidence, and renal failure was associated with the highest mortality. Conclusions In the course of acute pancreatitis, single organ dysfunction has the highest incidence but the mortality is low. Four or more organs dysfunction has the lowest incidence, but the mortality is 100%. Respiratory and cardiovascular dysfunction has the highest incidence, and renal, hematologic dysfunction is associated with poorest prognosis.