摘要
目的 探讨不同时期重症急性胰腺炎临床特点及疾病转归的影响因素.方法 回顾性选取2018年1月至2023年9月淮安市第二人民医院收治的150例重症急性胰腺炎患者作为研究对象,依照患者病程分为急性反应期(n=43)、全身感染期(n=55)和残余感染期(n=52),分析不同时期重症胰腺炎患者的临床症状、并发症发生情况、血清指标[血淀粉酶、C反应蛋白(CRP)、白细胞计数、降钙素原、白细胞介素-6(IL-6)、血清白蛋白、血红蛋白]水平.并收集患者年龄、体重指数、合并基础疾病、高脂饮食、吸烟史、饮酒史以及急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分水平.对150例重症胰腺炎患者进行院内随访,院内死亡的13例患者为预后不良,其余137例患者为预后良好.采用Logistics回归模型分析重症急性胰腺炎预后不良的独立危险因素.结果 不同时期重症急性胰腺炎患者临床症状比较,差异有统计学意义(P＜0.05),急性反应期主要以腹痛/腹胀、低血压休克、全腹膨隆、移动性浊音阳性、肠鸣音少而弱、呼吸困难、少尿/无尿、上消化道出血等严重症状为主,全身感染期严重症状减轻,以持续发热、恶心/呕吐为主,残余感染期严重症状基本消失,以腹膜腔残余的脓肿为主.不同时期重症急性胰腺炎患者急性呼吸窘迫综合征、肾功能不全、胰周积液、坏死感染、胰周脓肿、全身营养不良相关并发症比较,差异均有统计学意义(P＜0.05),急性反应期以急性呼吸窘迫综合征、肾功能不全为主,全身感染期为并发症高发期,以胰周积液、坏死感染、胰周脓肿为主,残余感染期以全身营养不良为主.不同时期重症胰腺炎患者血淀粉酶、CRP、白细胞计数、降钙素原、IL-6、血清白蛋白水平比较,差异均有统计学意义(P＜0.05),急性反应期的血淀粉酶高于全身感染期和残余感染期,全身感染期的CRP、白细胞计数、降钙素原、IL-6均高于急性反应期和残余感染期,残余感染期的血清白蛋白、血红蛋白水平均低于急性反应期和全身感染期,差异均有统计学意义(P＜0.05).Logistics回归模型分析结果显示,合并并发症、血淀粉酶、CRP、降钙素原、IL-6、血清白蛋白、血红蛋白、APACHE Ⅱ评分是重症急性胰腺炎预后不良的独立危险因素(P＜0.05).结论 同时期重症急性胰腺炎的临床症状、并发症以及血液相关指标差异均有统计学意义,且合并并发症、血淀粉酶、CRP、白细胞计数、降钙素原、IL-6、血清白蛋白、血红蛋白、年龄、高脂饮食、APACHE Ⅱ评分为影响重症急性胰腺预后转归的独立因素,对患者病情评估具有参考意义.
Abstract
Objective To explore the clinical characteristics and influencing factors of disease prognosis of severe acute pancreatitis in dif-ferent stages.Methods A total of 150 patients with severe acute pancreatitis admitted to Huai'an Second People's Hospital from January 2018 to September 2023 were retrospectively selected as the research subjects.They were divided into acute response phase(n=43),systemic infection phase(n=55),and residual infection phase(n=52)according to the patient's disease course.The clinical symptoms,incidence of complica-tions,and serum indicators[blood amylase,C-reactive protein(CRP),white blood cell count,procalcitonin,interleukin-6(IL-6),serum albumin,and hemoglobin]of patients with severe pancreatitis at different stages were analyzed.The age,body mass index,comorbidities,high-fat diet,smoking history,drinking history,and acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ)score levels of the patients were collected.Subsequently,150 patients with severe acute pancreatitis were followed up in the hospital,13 patients who died in the hospital had a poor prognosis,and the remaining 137 patients had a good prognosis.The independent risk factors for poor prognosis in severe acute pancreatitis were analyzed using a Logistic regression model.Results There were statistically significant differences in clinical manifestations among patients with severe acute pancreatitis at different stages(P＜0.05),during the acute response period,the main symptoms were abdominal pain/bloa-ting,hypotensive shock,total abdominal distension,positive mobility dullness,weak bowel sounds,difficulty breathing,oliguria/anuria,upper gastrointestinal bleeding,and other serious symptoms;during the systemic infection period,severe symptoms were alleviated,with persistent fever,nausea/vomiting being the main symptoms;the severe symptoms during the residual infection period had basically disappeared,mainly with residu-al abscesses in the peritoneal cavity.There were statistically significant differences in the comparison of complications related to acute respiratory distress syndrome,renal insufficiency,peripancreatic fluid accumulation,necrotic infection,peripancreatic abscess,and systemic malnutrition in patients with severe acute pancreatitis at different stages(P＜0.05).The acute response period was mainly characterized by acute respiratory dis-tress syndrome and renal insufficiency,while the systemic infection period was the high incidence period of complications,with peripancreatic fluid accumulation,necrotic sensation,and peripancreatic abscess being the main ones,the residual infection period was mainly characterized by sys-temic malnutrition.There were statistically significant differences in serum amylase,CRP,white blood cell count,procalcitonin,IL-6,serum al-bumin,and levels among patients with severe pancreatitis at different stages(P＜0.05);the levels of blood amylase in the acute response phase were higher than those in the systemic infection phase and residual infection phase,while the levels of CRP,white blood cell count,procalcitonin,and IL-6 in the systemic infection phase were higher than those in the acute response phase and residual infection phase,the the levels of serum albumin and hemoglobin during the residual infection period were lower than those during the acute response period and the systemic infection peri-od,and the differences were statistically significant(P＜0.05).The results of the Logistic regression model analysis showed that complications,blood amylase,C-reactive protein,procalcitonin,IL-6,serum albumin,hemoglobin,and APACHE Ⅱ scores were independent risk factors for poor prognosis in severe acute pancreatitis(P＜0.05).Conclusion There are statistically significant differences in clinical symptoms,compli-cations,and blood related indicators of severe acute pancreatitis during the same period,and comorbidities,blood amylase,C-reactive protein,white blood cell count,procalcitonin,IL-6,serum albumin,hemoglobin,age,high-fat diet,and APACHE Ⅱ scores are independent factors that affect the prognosis of severe acute pancreatitis,which has reference significance for patient condition evaluation.
基金项目
江苏省重点实验室开放课题(XZSYSKF2021036)
NETL
NSTL
维普
万方数据