糖尿病患者合并急性重症胆管炎的治疗及预后多因素分析

目的探讨糖尿病患者合并急性重症胆管炎(ACST)的治疗及预后的危险因素。方法对解放军264医院2005年1月至2011年12月收治的158例糖尿病合并ACST的患者进行回顾性分析。结果 158例患者围术期死亡12例。单因素和多因素Logistic回归分析显示患者的年龄≥65岁、入院时有精神症状、有多器官衰竭、有酸中毒的情况和手术时间≥6 h是预后不良的独立危险因素。结论高龄、存在精神症状、多器官衰竭、酸中毒程度和延迟手术的患者预后不佳。针对危险因素进行预防,尤其是术前积极改善酸中毒、掌握最佳手术时机,及时正确的治疗和预防措施是提高治愈率的关键。

Treatment and Prognostic Multiple Factors Analysis of Diabetic Patients Complicated with Acute Severe Cholangitis

Objective To investigate the effect of treatment and prognostic risk factors of diabetic patients complicated with acute severe cholangitis.Methods 158 cases of diabetes complicated with acute severe cholangitis from PLA 264th Hospital in January 2005 to December 2011 year were retrospectively analyzed.Results 12 patients died during perioperation period out of 158 the cases.Univariate and multivariate Logistic regression analysis showed that the patient′s age≥65 years,with psychotic symptoms at the time of admission,with multiple organ failure,acid degree of poisoning and the operative time≥6 h were independent risk factors for poor prognosis.Conclusion Advanced age,presence of psychotic symptoms,multiple organ failure,acidosis and delayed operation in patients have poor prognosis.Prevention from the risk factors,especially a positive preoperative improvement of acidosis,grasping the optimal timing of operation,timely and correct treatment and preventive measures are the keys to increase the cure rate.