腹膜后经皮穿刺置管引流治疗感染性胰腺坏死失败的风险因素分析

Analysis of risk factors for the failure of retroperitoneal percutaneous catheter drainage for infected pancreatic necrosis

目的探究腹膜后经皮穿刺置管引流(PCD)治疗感染性胰腺坏死(IPN)失败的风险因素。方法回顾性分析2019年1月至2023年4月安徽医科大学第二附属医院重症医学一科收治的行PCD治疗的68例IPN患者的临床资料,其中男性43例,女性25例,年龄(49.0±16.3)岁。根据PCD治疗效果分为两组:PCD成功组(n=26)和PCD失败组(n=42)。收集记录患者入院时疾病严重程度评分、实验室指标,记录置管后48 h患者重要器官功能评分、肠内营养等数据。对上述指标进行单因素分析,将单因素分析中P<0.05的变量纳入多因素logistic回归分析,分析PCD失败的影响因素。结果两组患者的入院24 h内急性生理和慢性健康状况(APACHEⅡ)评分、首次PCD前改良的CT严重指数(MCTSI)评分、首次PCD前行增强CT检查时间、首次PCD前急性肾损伤(AKI)、首次PCD前急性呼吸窘迫综合征(ARDS)、首次PCD前去甲肾上腺素总量、首次PCD后48 h内APACHEⅡ评分、首次PCD后48 h内序贯器官衰竭(SOFA)评分、引流液培养结果、开始实施肠内营养的时间比较,差异均有统计学意义(均P<0.05)。多因素分析显示,首次PCD前ARDS(OR=4.682,95%CI:1.010~21.692)、首次PCD前MCTSI评分越高(OR=2.125,95%CI:1.198~3.767)、开始实施肠内营养的时间越晚(OR=1.286,95%CI:1.020~1.622)、首次PCD后48 h内SOFA评分越高(OR=1.579,95%CI:1.142~2.183)的IPN患者,PCD失败的风险增加(均P<0.05)。结论首次PCD前ARDS、首次PCD前MCTSI评分越高、首次PCD后48 h内SOFA评分越高和实施肠内营养的时间越晚是PCD治疗IPN患者失败的风险因素。

Objective To study the risk factors for the failure of retroperitoneal percutaneous catheter drainage(PCD)for infected pancreatic necrosis(IPN).Methods The clinical data of 68 patients with IPN treated with PCD in the Second Affiliated Hospital of Anhui Medical University from January 2019 to April 2023 were retrospectively analyzed,including 43 males and 25 females,aged(49.0±16.3)years old.Patients were divided into the PCD success group(n=26)and PCD failure group(n=42).The score of disease severity and laboratory indices before PCD and the vital organ function scores and enteral nutrition tolerance 48 hours after PCD were collected and accessed by univariate analysis,and factors with P<0.05 were included in the logistic multivariate regression analysis for the risk factors of PCD failure.Results There were statistical significance in the acute physiological and chronic health status(APACHEⅡ)score within 24 hours of admission;the modified CT severity index(MCTSI)score,time of enhanced CT scan,acute kidney injury,acute respiratory distress syndrome(ARDS),and the total amount of noradrenaline before first PCD;the APACHE II score and sequential organ failure(SOFA)score within 48 hours after first PCD;and the culture results of drainage and start of enteral nutrition in the two groups(all P<0.05).Multifactorial logistic regression analysis showed that the occurrence of ARDS before first PCD(OR=4.682,95%CI:1.010-21.692,P=0.048),the delayed start of enteral nutrition(OR=1.286,95%CI:1.020-1.622,P=0.033),the high MCTSI score before first PCD(OR=2.125,95%CI:1.198-3.767,P=0.010),and high SOFA score within 48 hours after first PCD(OR=1.579,95%CI:1.142-2.183,P=0.006)were independent risk factors for the failure of PCD.Conclusion Patients with ARDS before first PCD,high MCTSI score before first PCD,high SOFA score within 48 hours after first PCD,and the delayed start of enteral nutrition were risk factors for the failure of PCD for IPN.