重型急性胰腺炎的危险因素分析

Analysis of Risk Factors in Patients with Severe Acute Pancreatitis

本文将重型急性胰腺炎生存的９１例和死亡的４６例，进行对比性研究。结果表明，下列各项是简便、快速、比较敏感和特异的早期评估重型急性胰腺炎预后的指标：①年龄大于４０岁；②胃肠道或皮下出血；③少尿或无尿；④意识障碍；⑤收缩压小于１２ｋＰａ；⑥心率大于１２０次／分；⑦呼吸大于３５次／分；⑧血肌酐大于１７７μｍｏｌ／Ｌ；⑨血糖大于１１．１ｍｍｏｌ／Ｌ；血尿素氮大于或等于１４．３ｍｍｏｌ／Ｌ。阳性项目大于或等于３者，预示病情严重，病死率高。其准确度、灵敏度、特异度、阳性预测值和阴性预测值分别为７８．８３％、６５．２２％、８５．７１％、６９．７７％和８２．９８％。

The main purpose of the study was undertaken to evaluate simple early findings which may predict the prognosis of the patients with severe acute pancreatitis (SAP).One hundred and thirty-seven patients with SAP were evaluated. In 87 patients,the diagnosis was proved at laparotomy and/or autopsy,Forty-six patients died. Statistical analysis of 35 early objective findings on admission identified 10 that were of significant prognostic value, Death correlated with: (1) afle over 40 years;(2) gastrointestinal or subcutaneous bleeding;(3)oliguria or anuria;(4)disturbance of consciousness; (5) systolic blood pressure <12 kPa(90 mmHg);(6)heart rate>120 per minute; (7)respiratory rate >35 per minute; (8)blood creatinine over 177μmol/L;(9) bloodglucose over 11. 1 mmol/L; and(10 )Hood urea nitrogen over 14. 3 mmol/L.When there was 1 resk factor, the mortality was 9. 09%; when there were 2-5risk factors,the mortality was 40.0%～88. 88%;when there were 6 or more risk factors,the mortality was 100%. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the prediction of these criteria were 78. 83%, 65. 22%, 85. 71%, 69. 77%and 82. 98%, respectively. These results suggest that the simple prognostic criteria might be valuable in early identification of risk patients with SAP.