重症急性胰腺炎并发持续性炎症反应-免疫抑制-分解代谢综合征临床分析

发布时间：2018-06-05 08:52

本文选题：重症急性胰腺炎 + 持续性炎症反应-免疫抑制-分解代谢综合征　；参考：《医学研究生学报》2017年07期

【摘要】：目的重症急性胰腺炎(SAP)并发持续性炎症反应-免疫抑制-分解代谢综合征(PICS)患者临床特征及危险因素研究较少。文中旨在总结SAP并发PICS患者的临床特点,对PICS发病的影响因素进行多元回归分析。方法回顾性分析2014年1月1日至2015年12月31日南京军区南京总医院普外科ICU住院时间14 d的214例SAP患者临床资料。依据PICS诊断标准分成2组:PICS组(149例,SAP并发PICS患者)和非PICS组(65例,SAP患者未并发PICS)。比较2组患者全身系统性并发症和胰腺炎特异性并发症,ICU病死率及随访13个月的存活率;并对PICS发病的影响因素进行多元回归分析。结果 PICS组胆源性SAP、MODS发生率较非PICS组明显升高(44.3%vs 29.2%、93.3%vs 55.4%,P0.05)。多元回归分析显示:BMI24(OR=2.307,95%CI:1.033~5.156)、胆源性病因(OR=4.207,95%CI:1.364~12.974)和多器官功能障碍综合征(MODS)(OR=4.384,95%CI:1.334~14.405)是并发PICS的危险因素。随访13个月的患者存活率PICS组较非PICS组明显降低(88.5%vs 98.2%,P=0.036)。结论在临床救治过程中,尤其需要警惕存在肥胖、胆源性病因以及MODS的SAP并发PICS患者。合并PICS可能是SAP患者预后不良的重要标志。
[Abstract]:Objective to study the clinical characteristics and risk factors of severe acute pancreatitis (SAP) complicated with persistent inflammatory reaction-immunosuppressive catabolism syndrome (PICSs). The purpose of this article is to summarize the clinical features of SAP complicated with PICS and to analyze the influencing factors of PICS by multivariate regression analysis. Methods from January 1, 2014 to December 31, 2015, the clinical data of 214 patients with ICU in general surgery department of Nanjing military region General Hospital, Nanjing military region from January 1, 2014 to December 31, 2015, who were hospitalized for 14 days, were retrospectively analyzed. According to the diagnostic criteria of PICS, two groups were divided into two groups: PICS group (n = 149) and non PICS group (n = 65). The mortality and the survival rate of 13 months follow-up were compared between systemic and pancreatitis specific complications in two groups, and the influencing factors of PICS were analyzed by multivariate regression analysis. Results the incidence of biliary SAP mods in PICS group was significantly higher than that in non PICS group. The multiple regression analysis showed that the risk factors of PICS were: BMI24: 2.307 ~ 95CI: 1.033 / 5.156, OR 4.207 ~ 95 CI: 1.364 ~ 12.974) and MODS 4.384 ~ 95 CIW 1.33414.405). The survival rate of patients in the PICS group was significantly lower than that in the non-PICS group after 13 months follow-up. The survival rate was significantly lower in the PICS group than in the non-PICS group. Conclusion in the course of clinical treatment, it is necessary to be on guard against SAP complicated with PICS with obesity, choledochogenic etiology and MODS. PICS may be an important marker of poor prognosis in patients with SAP.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)全军普通外科研究所;
【基金】：国家自然科学基金(81570584) 江苏省社会发展项目(BE2015685)
【分类号】：R576

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