重症胰腺炎合并脓毒症的影响因素分析

目的分析重症胰腺炎(SAP)合并脓毒症的相关因素。方法回顾性分析2007年1月—2020年3月收治的178例SAP患者的临床资料,根据是否并发脓毒症分为脓毒症组(n=56)与非脓毒症组(n=122)。计量资料两组间比较采用t检验,计数资料两组间比较采用χ²检验。多因素分析采用logistic回归分析。结果SAP患者脓毒血症的发生率为31.46%。单因素分析显示,APACHEⅡ评分、血糖、血钙、血清总胆固醇、血清甘油三酯、血尿素氮、血清肌酐、血清白蛋白,以及入住ICU、低氧血症、深静脉置管、机械通气、手术方式、血液净化、留置导尿、胰腺坏死范围在脓毒症和非脓毒症患者间差异均有统计学意义(P值均<0.05)。多因素分析结果显示,APACHEⅡ评分(OR=6.748,95%CI:2.191~20.788)、低氧血症(OR=3.383,95%CI:1.112~10.293)、血糖(OR=5.288,95%CI:1.176~23.781)、胰腺坏死范围(OR=5.523,95%CI:1.575~19.360)、血清肌酐(OR=5.012,95%CI:1.345~18.762)等5个因素是SAP并发脓毒症的独立危险因素(P值均<0.05),腹腔镜清除病灶坏死组织(OR=0.250,95%CI:0.066~0.951)为SAP并发脓毒症的独立保护因素(P<0.05)。结论控制血糖,保护肺肾等重器官功能,采用微创手术方式清除病灶坏死组织,注意重症、胰腺坏死程度高患者的救治是减少SAP并发脓毒症的重要措施。

Influencing factors for severe acute pancreatitis with sepsis

Objective To investigate related factors for severe acute pancreatitis(SAP)with sepsis.Methods A retrospective analysis was performed for the clinical data of 178 SAP patients who were admitted from January 2007 to March 2020,and according to the presence or absence of sepsis,they were divided into sepsis group with 56 patients and non-sepsis group with 122 patients.The t-test was used for comparison of continuous data between the two groups,and the chi-square test was used for comparison of categorical data between the two groups.A logistic regression model was used for multivariate analyses.Results The incidence rate of sepsis was 31.46%in SAP patients.The univariate analysis showed that there were significant differences between the patients without sepsis and those with sepsis in APACHEⅡscore,blood glucose,blood calcium,serum total cholesterol,serum triglyceride,blood urea nitrogen,serum creatinine,serum albumin,admission to the intensive care unit,hypoxemia,deep venous catheterization,mechanical ventilation,surgical procedure,blood purification,indwelling urinary catheterization,and extent of pancreatic necrosis(all P<0.05).The multivariate analysis showed that APACHEⅡscore(odds ratioOR]=6.748,95%confidence intervalCI]:2.191-20.788,P<0.05),hypoxemia(OR=3.383,95%CI:1.112-10.293,P<0.05),blood glucose(OR=5.288,95%CI:1.176-23.781,P<0.05),extent of pancreatic necrosis(OR=5.523,95%CI:1.575-19.360,P<0.05),and serum creatinine(OR=5.012,95%CI:1.345-18.762,P<0.05)were independent risk factors for infectious SAP with sepsis,while laparoscopic removal of focal necrotic tissue(OR=0.250,95%CI:0.066-0.951,P<0.05)was an independent protective factor against SAP with sepsis.Conclusion There are several important measures to reduce SAP with sepsis,including blood glucose control,protection of the functions of important organs such as lungs and kidneys,application of minimally invasive surgery to remove focal necrotic tissue,and emphasis on the treatment of critically ill patients with a high degree of pancreatic necrosis.