摘要
目的 探讨重症急性胰腺炎(SAP)患者早期外源性液体摄入与胰腺外渗出变化之间的关系.方法 回顾性收集2020年4月～2023年2月于我院ICU治疗的SAP患者210例,按照胰腺外渗出体积的差值(△vol)4分位数从低到高将其等分为Q1组(53例)、Q2组(49例)、Q3组(55例)和Q4组(53例).比较4组患者一般临床资料、实验室检查指标、临床评分、液体复苏和外源性摄入情况.采用多元线性回归分析探讨外源性液体摄入参数与△vol的关系;采用多元逐步回归分析评估△vol的影响因素,构建△vol的结构方程模型并分析和验证.结果 Q1组、Q2组、Q3组及Q4组患者IL-10、WBC计数、血清淀粉酶(AMS)、血清脂肪酶(LPS)水平、相邻CT扫描期间液体净摄入量(Tnet)、相邻CT扫描期间每日液体净摄入量(Pnet)、相邻CT扫描期间静脉液体摄入量(Tiv)、相邻CT扫描期间每日液体静脉摄入量(Piv)及△vol均依次升高;Q3组入ICU时急性生理学及慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分及急性胰腺炎的CT严重度指数(CTSI)评分均高于Q1组,Ranson评分均高于Q1组和Q2组,穿刺引流患者比例低于Q1组;Q4组入ICU时APACHE Ⅱ评分高于Q1组,CTSI评分均高于Q1组、Q2组和Q3组,Ranson评分均高于Q1组和Q2组,穿刺引流患者比例均低于Q1组和Q2组(P＜0.05).多元线性回归分析结果显示,△vol和Piv存在独立相关性(P＜0.001).多元逐步回归分析结果显示,穿刺引流、CTSI评分、Ranson评分、AMS、LPS、Piv均是△vol的独立危险因素(P＜0.05).构建△vol的结构方程模型,拟合优度指数(GFI)为0.954;区分效度检验结果显示,平均方差提取(AVE)值大于其他潜在变量.结论 穿刺引流、CTSI评分、Ranson评分、AMS、LPS、Piv均是△vol的独立危险因素.预测△vol的结构方程模型具有较好的区分度及准确度.
Abstract
Objective To investigate the relationship between early exogenous fluid intake and changes in pancreatic exudation in patients with severe acute pancreatitis(SAP).Methods A total of 210 SAP patients treated in ICU of our hospital from April 2020 to February 2023 were retrospectively collected and equally divided into Q1 group(53 cases),Q2 group(49 cases),Q3 group(55 cases),Q4 group(53 cases)according to fourth quantile of the difference in pancreatic expulsive volume(△vol).General clinical data,laboratory test indexes,clinical scores,fluid resuscitation and exogenous intake were compared among 4 groups.Multiple linear regression was used to analyze the relationship between exogenous fluid intake parameters and △vol.Multiple stepwise regression analysis was used to evaluate the influencing factors of△vol,and the structural equation model of △vol was constructed,analyzed and tested.Results IL-10,WBC count,serum amylase(AMS),serum lipase(LPS)levels,net fluid intake during adjacent CT scans(Tnet),net daily fluid intake during adjacent CT scans(Pnet),intravenous fluid intake during adjacent CT scans(Tiv),daily intravenous fluid intake during adjacent CT scans(Piv)and △vol were increased gradually in Q1,Q2,Q3 and Q4 groups;acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and CT severity index(CTSI)score of acute pancreatitis in Q3 group were higher than those in Q1 group,Ranson score was higher than that in Q1 group and Q2 group,and the proportion of patients with puncture drainage was lower than that in Q1 group at ICU admission;APACHE Ⅱ score in Q4 group was higher than that in Q1 group,CTSI score was higher than that in Q1 group,Q2 group and Q3 group,Ranson score was higher than that in Q1 group and Q2 group,the proportion of patients with puncture drainage was lower than that in Q1 group and Q2 group at ICU admission(P＜0.05).Multivariate linear regression analysis result showed that △vol was independently correlated with Piv(P＜0.001).Multiple stepwise regression analysis result showed that puncture and drainage,CTSI score,Ranson score,AMS,LPS and Piv were all independent risk factors for △vol(P＜0.05).The structural equation model of△vol was constructed,and the goodness of fit index(GFI)was 0.954;the results of discriminant validity test showed that average variance extracted(A VE)value was larger than other latent variables.Conclusion Puncture and drainage,CTSI score,Ranson score,AMS,LPS and Piv were all independent risk factors for△vol.The structural equation model for predicting △vol has good discrimination and accuracy.
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