急性胰腺炎并发急性肺损伤的影响因素及临床意义

Impact factors and clinical significance of the lung injury complicating acute pancreatitis

目的 探讨急性胰腺炎患者并发急性肺损伤的影响因素及临床意义。方法 对 2 5 0例急性胰腺炎患者进行回顾性分析 ,观察不同临床分型、病程不同时期和有无全身炎症反应综合征 (SIRS)及持续时间对肺损伤发生率的影响。同时分析急性胰腺炎并发急性肺损伤时与病情严重程度如急性生理学与慢性健康状况 (APACHE )评分、急性呼吸窘迫综合征 (ARDS)和多器官功能障碍综合征 (MODS)发生率以及预后的关系。结果 急性胰腺炎的不同临床分型、病程不同时期急性肺损伤的发生率有显著差异 (P均 <0 .0 1) ;SIRS组的急性肺损伤的发生率和非 SIRS组有显著差异 (P<0 .0 1) ;SIRS持续时间越长 ,急性肺损伤的发生率越高。并发急性肺损伤组患者 APACHE 评分以及 ARDS和 MODS的发生率明显增加 ,两组间有显著差异 (P均 <0 .0 1)。急性肺损伤组治愈率下降、病死率增加 ,两组间有显著差异 (P<0 .0 5 )。结论 SIRS是引起并发急性肺损伤的重要因素 ,急性肺损伤对急性胰腺炎患者病情和预后有重要影响。

Objective To study the impact factors and clinical significance of the acute lung injury(ALI) complicating acute pancreatitis. Methods Two hundred and fifty patients with acute pancreatitis were retrospectively analyzed to study the impact of the clinical types, different stages of the disease, systemic inflammatory response syndrome(SIRS) and its duration on the incidence of ALI. Also, the relationship between ALI and severity of the disease, as shown by acute physiology and chronic health evaluationⅡ (APACHEⅡ)score, the incidence of acute respiratory distress syndrome(ARDS) and multiple organ dysfunction syndrome(MODS), and prognosis was analyzed in patients with acute pancreatitis. Results Our data showed that the clinical types and different stages of acute pancreatitis were significantly related to the incidence of ALI(P<0.01).The incidence of ALI was significantly higher in patients with SIRS compared with those no SIRS(P<0.01), and the longer the duration of SIRS, the higher was the incidence of ALI. In patients with ALI, APACHEⅡ score and incidence of ARDS and MODS (P<0.01) were significantly higher, and the prognosis was poor(P<0.05). Conclusion SIRS is an important factor that has strong influence on incidence of ALI, and the ALI is an important determinant of prognosis and severity of patients with acute pancreatitis.