急性重症胰腺炎患者死亡预后因素临床分析

目的探讨影响急性重症胰腺炎预后的可能有关因素。方法回顾性分析1998年1月～2010年3月76例急性重症胰腺炎(Ranson评分≥3分,且APACHEⅡ评分≥8分)患者的临床资料。按照患者是否于入院60日内死亡分为死亡组(n=11)和存活组(n=65)。分析患者APACHEⅡ评分、Ranson评分、年龄、氧合指数、血肌酐等12项指标。结果入院60日内死亡患者共11例。与存活组相比,死亡组APACHEⅡ评分高(16.57±3.10vs12.04±2.95,t=2.859,P=0.006),Ranson评分高(4.71±0.76vs3.87±0.73,t=2.859,P=0.006),氧合指数低[(221±41)mmHgvs(285±48)mmHg,t=-3.353,P=0.002],血钙低[(1.77±0.39)mmol/Lvs(1.98±0.39)mmol/L,t=-2.187,P=0.033],血肌酐高[(103.1±24.4)μmol/Lvs(78.4±14.5)μmol/L,t=2.607,P=0.037],血糖水平高[(13.7±2.8)mmol/Lvs(11.0±1.5)mmol/L,t=2.448,P=0.047],碱剩余值低[(-1.33±2.93)mmol/Lvs(0.70±2.23)mmol/L,t=-2.149,P=0.036],血红细胞压积值低(0.35±0.04vs0.40±0.04,t=-2.957,P=0.013)。结论 APACHEⅡ评分、Ranson评分、氧合指数、血钙、血肌酐、血糖水平、碱剩余、血红细胞压积值可能是早期判断急性重症胰腺炎患者预后的指标。

Prognostic Factors of Death in Patients with Severe Acute Pancreatitis

Objective To study the prognostic factors of severe acute pancreatitis.Methods We retrospectively analyzed clinical data of 76 patients with severe acute pancreatitis（Ranson score ≥3 points and APACHE Ⅱ score ≥8 points）who were treated in our hospital from January 1998 to March 2010.The patients who died in 60 days after admission was enrolled into death group（n=11）,and the others were set as a survival group（n=65）.The Ranson score,APACHE Ⅱ score,age,oxygenation index,serum creatine,glucose,calcium,base excess,and hematocrit were compared between the two groups.Results Death group showed significantly higher APACHE Ⅱ（16.57±3.10 vs 12.04±2.95,t=2.859,P=0.006）and Ranson scores（4.71±0.76 vs 3.87±0.73,t=2.859,P=0.006）,serum creatine [（103.1±24.4）μmol/L vs（78.4±14.5）μmol/L,t=2.607,P=0.037] and glucose [（13.7±2.8）mmol/L vs（11.0±1.5）mmol/L,t=2.448,P=0.047] than the survival group,but significantly lower oxygenation index [（221±41）mm Hg vs（285±48）mm Hg,t=-3.353,P=0.002],serum calcium [（1.77±0.39）mmol/L vs（1.98±0.39）mmol/L,t=-2.187,P=0.033],base excess [（-1.33±2.93）mmol/L vs（0.70±2.23）mmol/L,t=-2.149,P=0.036],and hematocrit（0.35±0.04 vs 0.40±0.04,t=-2.957,P=0.013）.Conclusions The Ranson score,APACHE Ⅱ score,oxygenation index,serum creatine,glucose,calcium,base excess,and hematocrit can be prognostic factors for patients with severe acute pancreatitis in early stage.