老年重症急性胰腺炎合并急性肺损伤/急性呼吸窘迫综合征的临床特点和预后相关因素分析

Clinical characteristics and prognostic factors of severe acute pancreatitis with ALI/ARDS in elderly patients

目的探讨老年重症急性胰腺炎(SAP)合并急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的临床特点和预后的相关危险因素。方法选取2018年1月至2020年12月商丘市第一人民医院收治的128例老年SAP合并ALI/ARDS患者,总结他们的临床特点,并采用多因素Logistic回归分析影响预后的危险因素。结果胰腺炎病因以胆源性、高脂血症为主,ALI 81例,ARDS 47例。以确诊ALI/ARDS后30 d为截点,80例患者死亡,死亡率为62.50%。单因素分析结果显示患者预后与年龄、查尔森合并症指数(CCI)评分、脓毒血症、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、早期肠内营养、腹腔间隔室综合征(ACS)、肺外器官功能衰竭数目、机械通气治疗时间和氧合指数相关(P<0.05)。多因素分析结果显示CCI评分≥3分、脓毒血症、APACHEⅡ评分≥20分、腹腔、肺外器官衰竭数目≥2、机械通气治疗时间≥5 d和氧合指数<200 mmHg是影响患者预后的独立危险因素(P<0.05)。结论老年SAP合并ALI/ARDS患者病情危重,死亡率高。对于合并症较多、感染严重、合并有ACS或ARDS患者、肺外多器官功能衰竭的患者,应密切关注病情变化,加强综合化和个体化治疗,降低此类患者的死亡率。

【Objective】To investigate the clinical characteristics and prognostic risk factors of severe acute pancreatitis(SAP)with acute lung injury(ALI)or acute respiratory distress syndrome(ARDS)in the elderly.【Methods】A total of 128 elderly SAP patients with ALI/ARDS admitted to our hospital from Jan 2018 to Dec 2020 were selected.Their clinical characteristics were summarized and the risk factors affecting prognosis were analyzed by multivariate logistic regression.【Results】The etiology of pancreatitis was mainly biliary and hyperlipidemia.There were 81 cases of ALI and 47 cases of ARDS.Thirty days after diagnosis of ALI/ARDS,80 patients died,with a mortality rate of 62.50%.Univariate analysis showed that the prognosis was correlated with age,score of Charlson comorbidity index(CCI),sepsis,APACHEⅡscore,early enteral nutrition,abdominal compartment syndrome(ACS),number of extrapulmonary organ failure,duration of mechanical ventilation treatment and oxygen index(P<0.05).Multivariate analysis showed that CCI score≥3,sepsis,APACHE II score≥20,abdominal cavity,number of extrapulmonary organ failure≥2,duration of mechanical ventilation≥5 d and oxygen index<200 mmHg were independent risk factors for prognosis(P<0.05).【Conclusion】Elderly SAP patients with ALI/ARDS are in critical condition and have a high mortality rate.For patients with more complications,severe infection,ACS or ARDS,and extrapulmonary multiple organ failure,we should pay close attention to the changes of the disease,strengthen comprehensive and individualized treatment,and reduce the mortality of such patients.