重症急性胰腺炎合并腹腔感染Logistic危险因素分析

The risk factors of severe acute pancreatitis patients with intra-abdominal infection

目的探讨衢州市人民医院重症急性胰腺炎(SAP)合并腹腔感染Logistic危险因素分析。方法选取2010年4月至2015年12月本院收治的560例SAP患者的资料,根据是否合并腹腔感染分为合并腹腔感染组(216例)和非合并腹腔感染组(344例)。对两组患者的一般资料、实验室指标、并发症及治疗情况进行比较,采用Logistic回归分析两组患者的差异性指标。结果两组患者的器官功能衰竭(4/216 vs.5/344,χ~2=4.257,P=0.002)、合并胸腔积液(104/216 vs.44/344,χ~2=20.450,P=0.003)、合并腹腔积液(144/216 vs.76/344,χ~2=26.740,P=0.001)、急性病生理学和长期健康评价(APACHE)Ⅱ评分[(17±4)分vs.(14±6)分,t=4.698,P=0.001]及Ranson评分[(3.8±0.8)分vs.(3.3±0.6)分,t=5.558,P=0.003]比较,差异均有统计学意义。两组患者的实验室指标中天冬氨酸氨基转移酶[(211±52)U/L vs.(100±24)U/L,t=15.819,P=0.002]和血钙[(1.6±0.4)mmol/L vs.(2.2±0.4)mmol/L,t=7.670,P=0.003]的比较差异均有统计学意义。两组患者并发症及治疗情况中机械通气(72/108 vs.46/172,χ~2=20.790,P=0.002)和肠功能障碍(80/108 vs.82/170,χ~2=8.820,P=0.001)比较差异均有统计学意义。Logistic回归分析显示,合并器官功能衰竭[OR=0.142,95%CI(0.530,0.901),P=0.031]、合并腹腔积液[OR=4.723,95%CI(1.489,2.888),P=0.002]、血钙水平[OR=4.913,95%CI(0.816,0.957),P=0.003]和肠功能障碍[OR=3.642,95%CI(0.547,0.954),P=0.002]为SAP合并腹腔感染的危险因素。结论合并器官功能衰竭、合并腹腔积液、血钙水平和肠功能障碍4个指标为SAP合并腹腔感染的危险因素。在对SAP合并腹腔感染患者进行治疗时应该针对以上4个因素采取有效预防措施。

Objective To investigate the risk factors of severe acute pancreatitis（SAP）patients with intra-abdominal infection in Quzhou People＇s Hospital. Methods A total of 560 SAP patients in this hospital from April 2010 to December 2015 were divided into patients complicated with intra-abdominal infection group（n = 216） and patients complicated without intra-abdominal infection group（n = 344）. The general data, laboratory index, complication and therapeutic condition of the two groups were compared; and the diversity indices were analyzed by Logistic regression. Results The number of organ failure（4/216 vs. 5/344, χ^2 = 4.257, P =0.002）, pleural effusion（104/216 vs. 44/344, χ^2 = 20.450, P = 0.003）, ascites（144/216 vs. 76/344, χ^2= 26.740, P = 0.001）, acute physiology and chronic health evaluation（APACHE） Ⅱ scores[（17 ± 4） vs.（14 ± 6）, t = 4.698, P = 0.001] and Ranson scores [（3.8 ± 0.8） vs.（3.3 ± 0.6）, t =5.558, P = 0.003] of these two groups were significantly different. The concentrations of aspartate aminotransferase [（211 ± 52） U/L vs.（100 ± 24） U/L, t = 15.819, P = 0.002] and blood calcium[（1.6 ± 0.4） mmol/L vs.（2.2 ± 0.4） mmol/L, t = 7.670, P = 0.003] both showed significant differences between the two groups. In addition, the mechanical ventilation（72/108 vs. 46/172, χ^2=20.790, P = 0.002） and bowel dysfunction（80/108 vs. 82/170, χ^2= 8.820, P = 0.001） cases in the complication and therapeutic condition showed significant differences between the two groups.Logistic regression analysis showed that organ failure [OR = 0.142, 95% CI（0.530,0.901）, P =0.031], ascites [OR = 4.723, 95%CI（1.489,2.888）, P = 0.002], blood calcium [OR = 4.913, 95%CI（0.816,0.957）, P = 0.003] and bowel dysfunction [OR = 3.642, 95% CI（0.547,0.954）, P = 0.002]were the risk factors for SAP patients complicated with intra-abdominal infection. Conclusions The organ failure, ascites, blood calcium and intestinal dysfunction were the risk factors for SAP patients complicated with intra-abdominal infection. To treat SAP patients with intra-abdominal infection, we should apply targeted and effective, effective precautions.