摘要
目的:探讨高原地区重症急性胰腺炎(severe acute pancreatitis,SAP)肺损伤发生情况,并分析相关危险因素.方法:收集2021年4月-2022年4月在我院重症监护病房诊治的70例SAP患者为观察对象,根据急性肺损伤诊断标准分为肺损伤组20例和非肺损伤组50例,观察并比较两组患者的一般资料、肺功能、序贯器官衰竭(SOFA)评分、急性生理与慢性健康(APACHE Ⅱ)评分、腹内压、合并疾病等,并进行危险因素分析.结果:①两组患者性别、年龄、病因、身体质量指数(BMI)、入院到发病时间比较,差异均无统计学意义(P＞0.05);②肺损伤组SOFA评分为(11.75±0.78)分、APACHE Ⅱ评分为(19.33±0.35)分、腹内压(14.58±1.11)cmH2O、合并低蛋白血症占比45.0％、合并糖尿病占比50.0％,均高于非肺损伤组(P＜0.05);③肺损伤组第1秒用力呼气容积(FEV1)为(56.22±2.10)mL、肺总量(TLC)为(2.33±0.24)L、用力肺活量(FVC)为(1.89±0.32)L、1秒率(FEV1/FVC)为(59.29±3.00)％,均低于非肺损伤组(P＜0.05);④Logistic回归分析结果显示:SOFA评分、APACHE Ⅱ评分、腹内压、低蛋白血症、糖尿病都是导致高原地区SAP肺损伤发生的重要因素,差异均有统计学意义(P＜0.05).结论:高原地区SAP患者容易发生肺损伤,可导致患者肺功能严重下降,SOFA评分、APACHE Ⅱ评分、腹内压、低蛋白血症、糖尿病都是导致高原地区SAP肺损伤发生的重要因素.
Abstract
Objective:Explore the incidence of severe acute pancreatitis(SAP)lung injury in high-altitude areas and analyze related risk factors.Methods:Collect 70 SAP patients who were treated in our intensive care unit from April 2021 to April 2022 as observation subjects.According to the diagnostic criteria of acute lung injury,they were divided into a lung injury group of 20 cases and a non lung injury group of 50 cases.Observe and compare the general information,lung function,sequential organ failure(SOFA)score,acute physiological and chronic health(APACHE Ⅱ)score,intra-abdominal pressure,and comorbidities of the two groups of patients,and conduct risk factor analysis.Results:There was no statistically significant difference in gender,age,etiology,BMI,and time from admission to onset between the two groups of patients(P＞0.05);The scores of SOFA(11.75±0.78)points,APACHE Ⅱ(19.33±0.35)points,intra-abdominal pressure(14.58±1.11)cmH2O,hypoproteinemia(45.0％)and diabetes(50.0％)in the lung injury group were higher than those in the non lung injury group(P＜0.05);The first second forced expiratory volume(FEV1)of the lung injury group was(56.22±2.10)mL,total lung capacity(TLC)was(2.33±0.24)L,forced vital capacity(FVC)was(1.89±0.32)L,and the first second rate(FEV1/FVC)was(59.29±3.00)％,all of which were lower than those of the non lung injury group(P＜0.05);Logistic regression analysis showed that SOFA score,APACHE Ⅱ score,intra-abdominal pressure,hypoproteinemia and diabetes were all important factors leading to SAP lung injury at high altitude,and the difference was statistically significant(P＜0.05).Conclusion:SAP patients at high altitude are prone to lung injury,which can lead to a serious decline in lung function.SOFA score,APACHE Ⅱ score,intra-abdominal pressure,hypoproteinemia,and diabetes are all important factors leading to lung injury in SAP at high altitude.
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