摘要
目的回顾性分析危重症患者继发胰腺损伤的相关危险因素及预后评价。方法选取2014年12月至2017年6月赤峰市医院ICU收治的危重症患者415例进行回顾性研究,其中继发性胰腺损伤患者160例作为观察组,非继发性胰腺损伤患者经倾向得分匹配法(PSM)筛选出160例作为匹配组。记录分析患者入院时的人口基线资料、急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)评分、血清淀粉酶(amylase, AMS)、白细胞(white blood cell, WBC)计数、血红蛋白(hemoglobin, Hb)、降钙素原(procalcitonin, PCT)、超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)及动脉血乳酸(polylactic acid, Lac)和氧分压(partial pressure of oxygen, PO_2)、平均动脉压(mean artery pressure, MAP)等指标,记录28d相关不良事件和28d死亡率。经logistic回归分析相关危险性因素及预后评价。结果与匹配组比较,观察组Hb、PO_2和MAP水平明显降低(P <0.05),外伤史和输血率明显增高(P<0.05)。多因素logistic回归分析显示,输血、手术及外伤增加,感染指标水平增高,缺氧及组织灌注不足均是继发性胰腺损伤的相关危险因素。观察组心肌损伤、心力衰竭、败血症和多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)均明显高于匹配组(P <0.05);按28d死亡率行多因素logistic回归分析,结果显示心肌损伤、败血症、心力衰竭、MODS、AMS水平和APACHEⅡ评分是继发性胰腺损伤预后的影响因素。结论感染、缺血再灌注损伤、缺氧、应激等因素是危重症患者继发性胰腺损伤的危险因素;继发性胰腺损伤可增加心肌损伤、败血症、心力衰竭和MODS的发生率,影响患者的预后。
Objective To analyze retrospectively risk factors and prognosis evaluation of secondary pancreatic injury in critical patients.Method A retrospective study of 415 critically ill patients in Department of ICU of Chifeng Hospital from December 2014 to June2017 was conducted,which 160 cases of secondary pancreatic injury group(T group) and 160 cases of matched group(group C) werescreened by tendency score matching method(PSM) in non-secondary pancreatic injury group.Population baseline data of patients,acutephysiology and chronic health evaluation Ⅱ score(APACHEⅡ score),Serum amylase(AMS),white blood cell count(WBC),hemoglobin(Hb),procalcitonin(PCT),Hype rsensitive C-reactive protein(hs-CRP),oxygen partial pressure(partial pressure of oxygen,PO2),meanarterial pressure(mean artery pressure,MAP)and arterial blood gas were recorded,acute physiology,chronic health evaluation Ⅱ score(APACHEⅡ score),Adverse events and mortality rates of 28 days were recorded.Related risk factors and prognosis were reviewed byLogistic regression analysis.Result Compared with group C,the levels of Hb,PO2 and MAP in group T were signi?cantly decreased(P<0.05),and the history of trauma and the rate of blood transfusion were signi?cantly higher(P<0.05).Multivariate Logistic regressionanalysis showed that blood transfusion,surgery and trauma increased,the level of infection index increased,hypoxia and tissue perfusioninsufficiency were secondary risk factors for pancreatic injury.Myocardial injury,sepsis,heart failure and MODS in group T weresigni?cantly higher than those in group C(P<0.05).Multivariate Logistic regression analysis was performed on myocardial injury,sepsis,MODS,AMS level and APACHEⅡ score according to mortality rates of 28 days.The results showed that the above indicators were riskfactors for prognosis of secondary pancreatic injury.Conclusion Secondary infection,ischemia reperfusion injury,hypoxia,stress factorsare the risk factors of secondary pancreatic injury.Secondary pancreatic injury can increase the incidence of myocardial damage,heartfailure,sepsis and MODS,affecting the prognosis of the patients.
作者
赵丽娜
杨飞
陈壮
ZHAO Li-na;YANG Fei;CHEN Zhuang(Intensive Care Unit,Chifeng Municipal Hospital,Chifeng Clinical Medical College of Inner Mongolia Medical University,Inner Mongolia Chifeng 024000,China)
出处
《中国医刊》
CAS
2019年第2期156-159,共4页
Chinese Journal of Medicine
关键词
危重症患者
继发性胰腺损伤
危险因素
预后
Critical patients
Secondary pancreatic injury
Risk factors
Prognosis
