重症急性胰腺炎并发急性呼吸窘迫综合征危险因素分析及风险评估模型的建立

Analysis of risk factors and establishment of risk assessment model of SAP complicated with ARDS

目的分析重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)的危险因素,并建立风险评估模型。方法回顾性分析219例SAP住院患者的临床资料,对比分析并发与未并发ARDS患者的年龄、性别、个人史、既往史、生命体征、实验室检查、APACHEⅡ评分、Ranson评分、感染等33项指标,对有统计学意义的指标再行多因素Logistic回归分析,建立风险评估模型并检验其准确率。结果 219例SAP患者并发ARDS 84例,ARDS发生率为38.4%;并发与未并发ARDS患者合并感染、呼吸、心率、中性粒细胞(PMN)、降钙素原(PCT)、C反应蛋白(CRP)、Ca^(2+)、血肌酐、总蛋白、白蛋白(ALB)、空腹血糖、氧合指数、pH、APACHEⅡ评分、Ranson评分值差异有统计学意义(P均<0.05),其中合并感染(OR=6.908,P=0.000)、呼吸频率>30次/min(OR=1.251,P=0.000)、CRP>150 mg/L(OR=1.010,P=0.009)、ALB>30 g/L(OR=0.871,P=0.001)、PMN>14×10~9/L(OR=1.135,P=0.011)、APACHEⅡ评分>11分(OR=1.312,P=0.000)、Ranson评分>5分(OR=1.713,P=0.007)与SAP并发ARDS有关。SAP并发ARDS风险评估模型为LogistARDS/SAP=-12.595+1.933×感染+0.224×呼吸+0.010×血清CRP-0.138×ALB+0.126×PMN+0.272×APACHEⅡ评分+0.538×Ranson评分,该模型的准确率为90.4%。结论 SAP并发ARDS的独立危险因素为合并感染、呼吸>30次/min及CRP>150μg/L、PNM>14×109/L、APACHEⅡ评分>11分、Ranson评分>5分,建立风险评估模型能够较准确地预测SAP并发ARDS。

Objective To analyze the risk factors for severe acute pancreatitis（SAP） complicated with acute respiratory distress syndrome（ARDS）,and to establish a risk assessment model.Methods The clinical data of 219 SAP inpatients were retrospectively analyzed.We observed the 33 relevant factors between the patients with ARDS and without ARDS,including age,sex,personal history,past history,general vital signs,laboratory tests,APACHEII score,etc.Multivariate Logistic regression analysis was performed on the indicators with statistical significance,and then we established the risk assessment model and tested its accuracy.Results Eighty-four cases developed to ARDS in 219 SAP patients,the incidence was 38.4%.Statistically significant differences were found in the concurrent infection,respiratory rate,reart rate,PMN,PCT,CRP,Ca（2＋）,SCr,ALB,TB,fasting blood-glucose（FBG）,PaO_2/FIO_2,PH,APACHEⅡscore and Ranson score between patients with ARDS and without ARDS（all P〈 0.05）; the concurrent infection（OR =6.908,P = 0.000）,respiratory rate（OR = 1.251,P = 0.000）,CRP（OR = 1.010,P = 0.009）,ALB（OR = 0.871,P= 0.001）,PMN（OR = 1.135,P = 0.011）,APACHEⅡ（OR = 1.312,P = 0.000） and Ranson score（OR = 1.713,P= 0.007） were associated with SAP complicated with ARDS.The risk assessment model of SAP complicated with ARDS was LogistARDS/SAP=-12.595 ＋ 1.933 × infection ＋ 0.224 × respiratory rate ＋ 0.010 × CRP-0.138 × ALB ＋ 0.126 × PMN＋ 0.272 × APACHEII ＋ 0.538 × Ranson,and the accuracy of this model was 90.4%.Conclusion The independent risk factors for SAP complicated with ARDS are concurrent infection,accelerated respiration,and increased CRP,PNM,APACHEⅡscore,and Ranson score.Establishing the risk assessment model can accurately predict the risk of SAP complicated with ARDS.