老年急性胰腺炎患者临床特征的单中心回顾性研究

A single-center retrospective study of clinical characteristics in elderly patients with acute pancreatitis

目的 探讨老年急性胰腺炎(acute pancreatitis,AP)患者的临床特征,为老年AP患者的防治提供依据。方法 收集2021年3月至2023年3月于扬州大学附属江都人民医院诊治的AP患者的临床资料,根据年龄将其分为老年组(年龄≥65岁,167例)和非老年组(年龄<65岁,303例)。比较两组患者的临床特征、生化指标、死亡率、重症监护病房(intensive care unit,ICU)住院率、住院时间、Ranson评分、查尔森合并症指数(Charlson comorbidity index,CCI)等。结果 老年组患者的年龄显著大于非老年组,乳酸脱氢酶、天冬氨酸转氨酶、血清淀粉酶、Ranson评分和心血管合并症、肺部合并症、神经系统合并症、CCI≥2的比例及黄疸发生率均显著高于非老年组(P<0.05),老年组患者的死亡率、ICU住院率均显著高于非老年组,住院时间显著长于非老年组(P<0.05)。多因素分析结果显示,年龄≥65岁、Ranson评分≥3分、CCI≥2、胰腺坏死均是AP患者死亡和进入ICU的独立危险因素(P<0.05),年龄≥65岁、胰腺坏死、胆源性病因是住院时间延长的独立危险因素(P<0.05)。结论 与中青年患者相比,老年AP患者的死亡率、ICU住院率较高,住院时间延长,早期识别和及时治疗是改善老年AP患者预后的关键因素。

Objective To investigate the clinical characteristics of elderly patients with acute pancreatitis(AP),and to provide a basis for the prevention and treatment of elderly patients with AP.Methods Clinical data of AP patients treated in Jiangdu People's Hospital Affiliated to Yangzhou University from March 2021 to March 2023 were collected and divided into elderly group(≥65 years old,167 cases) and non-elderly group(< 65 years old,303 cases) according to age.The clinical characteristics,biochemical indexes,mortality,intensive care unit(ICU) hospitalization rate,length of stay,Ranson score,Charlson comorbidity index(CCI) and so on were compared between the two groups.Results The age of elderly group was significantly higher than that of non-elderly group,lactate dehydrogenase,aspartate aminotransferase,serum amylase,Ranson score,the proportion of cardiovascular complications,pulmonary complications,nervous system complications,CCI≥2 and the incidence of jaundice were significantly higher than those of non-elderly group(P<0.05).The mortality rate and ICU hospitalization rate of elderly group were significantly higher than that of non-elderly group,and the hospital stay was significantly longer than that of non-elderly group(P<0.05).Multivariate analysis showed that age ≥65 years,Ranson score ≥3,CCI≥2 and pancreatic necrosis were independent risk factors for death and ICU admission in AP patients(P<0.05),age ≥65 years,pancreatic necrosis,and biliary causes were independent risk factors for prolonged hospital stay(P<0.05).Conclusion Compared with middle-aged and young patients,elderly AP patients have higher mortality,higher ICU hospitalization rate and longer hospital stay.Early identification and timely treatment are key factors to improve prognosis elderly AP patients.