重症胰腺炎并发肠梗阻相关危险因素分析及诊治研究

Analysis of risk factors associated with severe pancreatitis complicated by intestinal obstruction and study of diagnosis and treatment

目的探讨重症急性胰腺炎(SAP)并发肠梗阻相关危险因素,并分析其诊治方法。方法选取2017年1月至2022年1月云南大学附属医院收治的261例SAP患者为研究对象,159例单纯性SAP患者设为SAP组,102例SAP并发肠梗阻患者设为肠梗阻组。比较两组临床资料,采用多因素Logistic回归方程分析SAP并发肠梗阻的相关影响因素,采用R语言绘制预测SAP并发肠梗阻的列线图模型。结果Ranson评分、改良的CT严重指数(MCTSI)评分、改良胃肠功能衰竭(iGIF)评分、十二指肠狭窄均是SAP并发肠梗阻的危险因素(P<0.05)。所构建的列线图模型预测SAP并发肠梗阻的C指数为0.976(95%可信区间:0.971~0.999)。结论Ranson评分、MCTSI评分、iGIF评分、十二指肠狭窄是SAP并发肠梗阻的影响因素,可为防治或预测肠梗阻提供参考,结合临床症状体征及腹部X线/CT检查可对肠梗阻做出准确诊断,大多肠梗阻患者经保守治疗可获满意预后,部分患者需接受手术治疗,早期的穿刺引流可避免因炎性坏死组织压迫造成结肠狭窄类梗阻的发生。

Objective To investigate the risk factors of severe acute pancreatitis(SAP)complicated with intestinal obstruction,and to analyze the diagnosis and treatment methods.Methods A total of 261 SAP patients admitted to the Affiliated Hospital of Yunnan University from January 2017 to January 2022 were selected as the study objects,159 patients with simple SAP were assigned to the SAP group,and 102 patients with SAP complicated with intestinal obstruction were assigned to the intestinal obstruction group.The clinical data of the two groups were compared,and the related influencing factors of SAP complicated with intestinal obstruction were analyzed by multi-factor Logistic regression equation,and a line graph model for predicting SAP complicated intestinal obstruction was drawn by R language.Result Ranson score,modified CT Severity Index(MCTSI)score,modified gastrointestinal failure(iGIF)score and duodenal stenosis were all risk factors for intestinal obstruction in SAP(P<0.05).The constructed line graph model predicted the C index of SAP complicated with intestinal obstruction to be 0.976(95%confidence interval:0.971-0.999).Conclusion The Ranson score,MCTSI score,iGIF and duodenal stenosis are all factors influencing the complication of intestinal obstruction in SAP,which can provide a reference for the prevention and treatment or prediction of intestinal obstruction,and the combination of clinical symptoms and signs and abdominal X-ray/CT examination can make an accurate diagnosis of intestinal obstruction.