重症急性胰腺炎致脓毒症与肺炎致脓毒症病情及预后的比较研究

A comparative study on the prognosis of sepsis caused by acute severe pancreatitis and pneumonia

目的比较重症急性胰腺炎(SAP)致脓毒症与社区获得性肺炎(CAP)致脓毒症的病情严重程度,提高对不同类型炎症反应致脓毒症的认识,为临床评估病情及预后提供依据。方法选取2018年11月至2020年10月北京市顺义区医院及北京中医药大学东直门医院收治的符合2016年sepsis-3诊断标准的脓毒症患者,筛选出SAP患者42例(SAP致脓毒症组)及CAP患者68例(CAP致脓毒症组)。回顾性分析临床资料,比较两组间不同时间点的各项指标、急性生理与慢性健康评分Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评分,并分析APACHEⅡ和SOFA评分及其他各指标的相关性。结果(1)SAP致脓毒症组死亡率显著低于CAP致脓毒症组(2.38%vs 41.18%,P<0.001),SAP致脓毒症组患者住院第1、3、7天的APACHEⅡ评分、SOFA评分显著低于CAP致脓毒症组患者相同时间点的评分(APACHEⅡ:10.55±1.16 vs 18.51±0.69,P<0.001、8.76±0.79 vs 15.45±1.12,P<0.001、7.77±0.77 vs 12.98±1.08,P<0.001;SOFA:3.71±0.53 vs 5.57±0.37,P<0.001、3.24±0.44 vs 5.21±0.52,P<0.001、2.87±0.14 vs 5.19±0.55,P<0.001)。(2)SAP致脓毒症组APACHEⅡ评分与Lac、PLT、PCO_(2)、Cr、AST以及SOFA评分存在相关性,SOFA评分则与Lac、CRP、PLT、PO_(2)、PCO_(2)、Cr、AST、ALT、APACHEⅡ存在相关性;CAP致脓毒症组APACHEⅡ评分与SOFA评分存在相关性。结论APACHEⅡ、SOFA评分与不同临床指标联合对于判断不同发病机制脓毒症患者的病情严重程度及预后评估有着良好的指示作用。

Objective To compare the severity of sepsis caused by severe acute pancreatitis(SAP)and community-acquired pneumonia(CAP),improve the understanding of sepsis caused by different types of inflammatory reaction,and provide basis for clinical evaluation of condition and prognosis.Methods From November 2018 to October 2020,42 patients with SAP(SAP induced sepsis group)and 68 patients with CAP(CAP induced sepsis group)were selected from Beijing Shunyi Hospital and Dongzhimen Hospital of Beijing University of Chinese medicine.All patients met the diagnostic criteria of sepsis-3 in 2016.The clinical data were analyzed retrospectively,and the indexes,Acute Physiology and Chronic Health Enquiry(APACHEⅡ)score and Sequential Organ Failure Assessment(SOFA)score at different time points between the two groups were compared.The correlation between APACHEⅡscore and SOFA score and other indicators was analyzed.Results(1)The mortality rate of SAP induced sepsis group was significantly lower than that of CAP induced sepsis group(2.38%vs 41.18%,P<0.001).The APACHEⅡscore and SOFA score of SAP induced sepsis group on the 1st,3rd and 7th day of hospitalization were significantly lower than those of CAP induced sepsis group at the same time point(APACHEⅡ:10.55±1.16 vs 18.51±0.69,P<0.001,8.78±0.79 vs 15.45±1.12,P<0.001,7.77±0.77 vs 12.98±1.08,P<0.001;SOFA:3.71±0.53 vs 5.57±0.37,P<0.001,3.24±0.44 vs 5.21±0.52,P<0.001,2.87±0.14 vs 5.19±0.55,P<0.001).(2)In SAP-induced sepsis group,APACHEⅡscore was correlated with lactic acid(Lac),platelet(PLT),PCO_(2),creatinine(Cr),aspartate transaminase(AST)and SOFA score,while SOFA score was correlated with Lac,C-reactive protein(CRP),PLT,PO_(2),PCO_(2),Cr,AST,alanine aminotransferase(ALT)and APACHEⅡscore.In CAP-induced sepsis group,APACHEⅡscore was correlated with SOFA score.Conclusions The combination of APACHEⅡscore,SOFA score and different clinical indexes has a good indication for judging the severity and prognosis of sepsis patients with different pathogenesis.