血液净化治疗老年重症急性胰腺炎多器官功能障碍综合征的预后及预警因素

Prognosis and early warning factors of disease in elderly patients with severe acute pancreatitis multiple organ dysfunction syndrome treated with blood purification

目的分析血液净化治疗老年重症急性胰腺炎多器官功能障碍综合征患者的预后及疾病发生的预警因素。方法选择郑州市第三人民医院2020年10月至2022年10月收治的老年重症急性胰腺炎患者88例,按照是否并发多器官功能障碍综合征将其分为2组(并发组和未并发组),分别于治疗前、治疗7 d后对所有患者急性生理与慢性健康评分(APACHEⅡ)、C反应蛋白(CRP)、白细胞介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)进行检测对比,并进行影响因素分析。结果治疗前所有患者APACHEⅡ评分为(15±5)分,治疗后(9±3)分,治疗后相较于治疗前下降(t=7.013,P<0.05)。治疗后CRP、IL-6、IL-10、TNF-α水平相较于治疗前均下降(P均<0.05),休克、胆道梗阻、低氧血症、肺部感染、胸腔积液、腹腔室隔综合征、Ranson评分、APACHEⅡ评分、胰腺病变程度CT分级评分均为老年重症急性胰腺炎并发多器官功能障碍综合征的预警因素(OR=1.187、1.014、1.003、1.005、1.050、1.060、1.079、1.009、1.030,P均<0.05)。结论对老年重症急性胰腺炎多器官功能障碍综合征采用连续血液净化治疗有助于减轻患者机体内炎症反应,疗效显著;老年重症急性胰腺炎并发多器官功能障碍综合征的预警因素在于休克、胆道梗阻、低氧血症、肺部感染、胸腔积液、腹腔室隔综合征、Ranson评分、APACHEⅡ评分、胰腺病变程度CT分级评分等,应针对性地对上述因素采取有效的干预措施,以改善患者预后。

Objective To analyze the prognosis and early warning factors of disease occurrence in elderly patients with severe acute pancreatitis multiple organ dysfunction syndrome treated with blood purification.Methods Eighty-eight cases of elderly patients with severe acute pancreatitis with multiple organ dysfunction syndrome admitted to the Third People′s Hospital of Zhengzhou from October 2020 to October 2022 were selected,and the elderly patients with severe acute pancreatitis were divided into two groups(concurrent and uncomplicated)according to whether they were concurrent with multiple organ dysfunction syndrome or not,and all the patients′Acute Physiological and Chronic Health Score(APACHEⅡ),C-reactive protein(CRP),interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-alpha(TNF-α)levels of all patients were detected and compared before treatment and after the 7th days of the treatment,respectively,and analysis of the influencing factors was performed.Results The APACHEⅡscore of all patients was(15±5)before treatment and(9±3)after treatment,which decreased after treatment compared with before treatment(t=7.013,P<0.05).CRP,IL-6,IL-10,and TNF-αlevels decreased after treatment compared to before treatment(all P<0.05),and shock,biliary obstruction,hypoxemia,pulmonary infection,pleural effusion,abdominal compartment syndrome,Ranson score,APACHEⅡscore,and CT grading score of the extent of pancreatic lesions were all severe acute pancreatitis complicated with multiorgan dysfunction syndrome in the elderly as Early warning factors(OR=1.187,1.014,1.003,1.005,1.050,1.060,1.079,1.009,1.030,all P<0.05).Conclusion The use of continuous blood purification treatment for severe acute pancreatitis with multiple organ dysfunction syndrome in the elderly can help to reduce the inflammatory response in the patient′s body,and the therapeutic efficacy is obvious.The warning factors of multiple organ dysfunction syndrome complicated by severe acute pancreatitis in the elderly are shock,biliary obstruction,hypoxemia,pulmonary infection,pleural effusion,abdominal compartment syndrome,Ranson score,APACHEⅡscore,CT grading score of the degree of pancreatic lesions,etc.Effective interventions for the above factors should be targeted to improve the prognosis of patients。