某三级医院急性胰腺炎患者急性肺损伤及其影响因素研究

发布时间：2018-04-23 04:24

本文选题：急性胰腺炎 + 急性肺损伤　；参考：《中南大学》2013年硕士论文

【摘要】：目的：描述和分析2008年1月1日至2012年12月31日期间急性胰腺炎患者的一般资料、病因、临床特点,分析急性胰腺炎急性肺损伤并发症的影响因素,为进一步提高急性胰腺炎的诊治水平,提高治疗疗效,降低病死率,提供可靠的、科学的的依据。方法：收集2008年1月1日至2012年12月31日期间在湖南省人民医院住院治疗的内科和外科的资料完整有效急性胰腺炎病例共432例。采用回归性分析,对急性胰腺炎的不同人群特征和急性肺损伤并发症相关影响因素进行统计分析。结果： 1.在本次收集的432例急性胰腺炎病例中,男性236例,占54.6%；女性病例196例,占45.4%；平均年龄47.7±16.4岁,急性胰腺炎的好发年龄集中在30-70岁；文化程度以高中／大专为主,占55.1%；职业以农民和公务员占大多数,农民112例,占25.9%；公务员48例,占20.5%。经济状况为一般的占大多数,达78.7%；医疗保健花费以社会医疗保险为主,占31.0%。男性吸烟者84例,占35.6%；女性吸烟者39例,占18.4%。男性饮酒者152例,占64.4%；女性饮酒者64例,占18.4%。伴随疾病中最常见的是高血压、脂肪肝、糖尿病,分别占24.1%、17.6%、15.7%。 2.轻型急性胰腺炎有296例,占68.5%,重型急性胰腺炎有136例,占31.5%。 3.发病原因中的主要病因是胆源性疾病、高脂血症性、酒精性、暴饮暴食性,分别占34.3%、14.6%、13.2%、10.2%,其他的病因还有外伤、手术、ERCP等其他原因。 4.临床症状主要是腹痛、发热、恶心、呕吐、腹胀、黄疸,分别达到了100.0%、72.2%、68.5%、63.4%、58.3%、30.6%。体征主要是腹部压痛、肠鸣音减弱、肌紧张、腹部反跳痛,分别达到了79.6%、38.9%、32.4%和28.7%。 5.B超诊断的阳性率为75.0%,经CT诊断的阳性率为96.3%,CT诊断急性胰腺炎的阳性率高于B超。 6.432例急性胰腺炎中发生急性肺损伤共39例,占9.03%。 7.疾病分型和入院时的乳酸脱氢酶、尿素氮、白细胞和动脉血氧分压是重症急性胰腺炎发生急性肺损伤的影响因素。结论： 1.该院432例急性胰腺炎患者中急性肺损伤并发症的发生率为9.03%。 2.重型急性胰腺炎和入院时的乳酸脱氢酶异常、尿素氮异常、白细胞异常、动脉血氧分压异常是急性胰腺炎并发急性肺损伤的危险因素。
[Abstract]:Objective: to describe and analyze the general data, etiology and clinical characteristics of patients with acute pancreatitis from January 1, 2008 to December 31, 2012, and to analyze the influencing factors of complications of acute lung injury in acute pancreatitis. In order to further improve the level of diagnosis and treatment of acute pancreatitis, improve the therapeutic efficacy, reduce the mortality, provide a reliable, scientific basis. Methods: 432 cases of complete and effective acute pancreatitis were collected from January 1, 2008 to December 31, 2012, which were hospitalized in Hunan Provincial people's Hospital. Regression analysis was used to analyze the different population characteristics of acute pancreatitis and the related factors of acute lung injury complications. Results: 1. Among the 432 acute pancreatitis cases collected, 236 cases were male (54.6%), 196 cases were female (45.4%), the average age was 47.7 卤16.4 years, the predilection age of acute pancreatitis was 30-70 years old. Peasants and civil servants accounted for the majority of the occupation, 112 for peasants, 25.9 for peasants, and 48 for civil servants, accounting for 20.5 percent. The average economic status was 78.7%, and the health care expenditure was mainly social medical insurance, accounting for 31.0%. There were 84 male smokers (35. 6%) and 39 female smokers (18. 4%). 152 cases (64.4%) were male drinkers and 64 cases (18.4%) were female drinkers. The most common concomitant diseases are hypertension, fatty liver and diabetes, accounting for 24.1and 17.6g / 15.7 respectively. 2. There were 296 cases of mild acute pancreatitis (68.5%) and 136 cases of severe acute pancreatitis (31.5%). 3. The main causes of the disease were biliary diseases, hyperlipidemia, alcoholism, and overeating, respectively, accounting for 34.30.14.6% and 13.2g / 10.2 respectively. The other causes were trauma, surgical ERCP and other causes. 4. The main clinical symptoms were abdominal pain, fever, nausea, vomiting, abdominal distension and jaundice, which reached 100.0, respectively. The main signs were abdominal tenderness, weakened bowel sounds, muscle tension, abdominal rebound pain, which reached 79.6% 38.9% and 28.7%, respectively. 5.The positive rate of B-ultrasonography was 75.0 and that of CT was 96.3and the positive rate of CT was higher than that of B-ultrasound. Acute lung injury occurred in 39 cases (9.03%) in 6.432 cases of acute pancreatitis. 7. Classification and admission of lactate dehydrogenase, urea nitrogen, white blood cell and arterial partial pressure of oxygen were the influencing factors of acute lung injury in severe acute pancreatitis. Conclusion: 1. The incidence of complications of acute lung injury in 432 patients with acute pancreatitis was 9.03. 2. Abnormal lactate dehydrogenase, abnormal urea nitrogen, abnormal white blood cell and abnormal arterial partial pressure of oxygen are the risk factors of acute pancreatitis complicated with acute lung injury.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R576;R563.8

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