上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (5): 640-.doi: 10.3969/j.issn.1674-8115.2013.05.026

• 论著（临床研究） • 上一篇    下一篇

重症急性胰腺炎死亡患者的临床特征分析

刘晓颖1, 黄 洁1, 费 健2, 毛恩强1, 汤耀卿1, 张圣道2, 陈尔真1   

  1. 上海交通大学 医学院附属瑞金医院 1.重症医学科, 2.普外科, 上海 200025
  • 出版日期:2013-05-28 发布日期:2013-05-28
  • 作者简介:刘晓颖（1986—）, 女, 住院医师, 硕士； 电子信箱: liuxiaoying0318@hotmail.com。
  • 基金资助:

    上海市科委重点项目（12411950500）

Clinical characteristics of dead patients with severe acute pancreatitis

LIU Xiao-ying1, HUANG Jie1, FEI Jian2, MAO En-qiang1, TANG Yao-qing1, ZHANG Sheng-dao2, CHEN Er-zhen1   

  1. 1.Department of Critical Care Medicine, 2.Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-05-28 Published:2013-05-28
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 12411950500

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摘要：

目的 分析重症急性胰腺炎（SAP）患者死亡相关的危险因素。方法 分析906例SAP患者的临床资料，根据患者的预后分为死亡组和存活组。比较死亡组与存活组患者的年龄、性别、急性生理与慢性健康(APACHE)Ⅱ评分、Ranson评分、CT严重指数（CTSI）、病因、单个或多脏器功能障碍/衰竭、手术、并发症等的差异。结果 死亡组患者149例，存活组患者757例。死亡组中，45.0%的患者死于发病14 d内。特发性SAP患者病死率（28.0%）高于胆源性SAP（16.6%）和高脂血症性SAP（5.5%），差异均有统计学意义（均P<0.05）。死亡组多脏器功能障碍/衰竭的发生率（76.5%）显著高于存活组（12.7%）（P<0.05）。在死亡组患者并发症中，严重脓毒血症的发生率（53.0%）最高，且显著高于存活组的23.2%（P<0.05）。死亡组清创手术率高于存活组，但差异无统计学意义(P>0.05)。结论 SAP患者的死亡与高龄、发病原因、多脏器功能障碍/衰竭、严重感染及局部并发症有关；重视个体化的诊断与评估，积极防治并发症和脏器功能损伤是改善预后的关键。

关键词: 重症急性胰腺炎, 死亡, 临床特征

Abstract:

Objective To investigate the risk factors of death in patients with severe acute pancreatitis (SAP). Methods The clinical data of 906 patients with SAP were retrospectively analyzed. Patients were divided into death group and survival group based on the outcomes. The age, gender, acute physiology and chronic health evaluation (APACHE) Ⅱ score, Ranson score, CT severity index (CTSI), disease cause, single or multiple organ dysfunction/failure, operation and complications were compared between two groups. Results There were 149 patients in death group and 757 patients in survival group. In death group, 45% patients died within 14 d after disease onset. The mortality of idiopathic SAP (28.0%) was higher than those of biliary SAP (16.6%) and hyperlipidemic SAP (5.5%)(P<0.05). The incidence of multiple organ dysfunction/failure in death group (76.5%) was significantly higher than that in survival group (12.7%)(P<0.05). The highest incidence of complications in death group was severe sepsis (53.0%), which was significantly higher than that in survival group (23.2%)（P<0.05）. The incidence of debridement in death group was higher than that in survival group (P>0.05). Conclusion The death of patients with SAP was associated with age, disease cause, multiple organ dysfunction/failure, severe infection and local complications. In order to decrease mortality, it is important to perform individual diagnosis and treatment, and prevent the complications and organ dysfunction promptly.

Key words: severe acute pancreatitis, mortality, clinical characteristics