重症急性胰腺炎合并胰性脑病的预警因素研究

目的探讨重症急性胰腺炎患者出现胰性脑病的临床特点、预警因素及预后。方法将2008年1月—2011年5月中心ICU收治的87例重症急性胰腺炎患者分为胰性脑病组和非胰性脑病组,对两组的临床资料进行回顾性分析。结果 20例患者出现胰性脑病,临床表现以兴奋性症状为主,病情恶化率明显高于非胰性脑病组(50.0%vs.25.4%,P=0.037)。单因素分析显示,胰性脑病组的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)、多器官功能衰竭(MODS)发生率、肌酐、三酰甘油、真菌感染率明显高于非胰性脑病组,差异有统计学意义(P<0.05)。Logistic回归分析显示,APACHEⅡ评分和三酰甘油是胰性脑病发生的预警因素,有统计学意义(P<0.05)。结论胰腺脑病是影响重症急性胰腺炎患者预后的不良因素,临床上以兴奋性症状为主,高三酰甘油血症和高APACHEⅡ评分是胰性脑病发生的预警因素。

Risk Factors for Severe Acute Pancreatitis Complicated with Pancreatic Encephalopathy

Objective To explore the clinical characteristics,risk factors,and prognosis of severe acute pancreatitis(SAP) complicated with pancreatic encephalopathy(PE).Methods A retrospective study was conducted on 87 cases of SAP admitted into our central ICU between January 2008 and May 2011.Results Of these 87 SAP patients,20 developed PE,which was featured by signs and symptoms of excited delirium;meanwhile,they had significantly higher mortality rate than the non-PE patients(50.0% vs 25.4%,P=0.037).Univariate analysis showed that Acute Physiology and Chronic Health Evaluation(APACHE) II Scores,multiple organ dysfunction syndrome(MODS) incidence,serum creatinine level,plasma triglyceride level,and fungal infection rate were significantly higher among PE patients than non-PE patients(P<0.05).Logistic regression analysis showed that APACHE II Scores and plasma triglyceride level were independent risk factors for PE(P<0.05).Conclusion PE,mainly manifested as excited delirium,can worsen the prognosis of SAP patients.High APACHE II Scores and hypertriglyceridemia are the main risk factors for PE.