重症急性胰腺炎早期合并胰腺感染临床特征及危险因素分析

摘要

目的研究重症急性胰腺炎（Severe acute pancreatitis，SAP）早期合并胰腺感染临床特征及危险因素。方法2008年7月至2011年3月SAP患者按是否出现胰腺感染进行分组回顾分析。观察组：64例，为SAP早期合并胰腺感染患者；对照组：139例，为未合并胰腺感染SAP患者。对两组患者治疗方式、临床特征进行比较，并对影响感染的因素进行回归分析。结果观察组APACHE II及Ranson评分明显高于对照组，其血Ca2+浓度低于后者，两组指标比较差异有统计学意义（P<0.05）。两组患者血淀粉酶、尿淀粉酶及甘油三酯指标比较差异无统计学意义（P>0.05）。观察组放置胃管≥7d患者及行腹腔手术患者比例明显高于对照组（P<0.05）。其他治疗方式两组患者比较差异无统计学意义（P>0.05）。APACHE II评分、Ranson评分、血Ca2+浓度、放置胃管≥7d及采取腹腔手术是影响SAP早期合并胰腺感染的危险因素。结论重症急性胰腺炎早期合并胰腺感染的主要临床表现为APACHE II评分及Ranson评分升高、血Ca2+浓度下降，而影响感染的危险因素有放置胃管≥7d及采取腹腔手术，因此在患者的确诊中应密切关注APACHE II评分、Ranson评分及血Ca2+浓度的变化，并缩短放置胃管时间，行积极非手术治疗，以降低胰腺感染发生率，提高患者生存质量。%Objective To study on severe acute pancreatitis(SAP)early pancreatic infection:clinical features and risk factors. Methods In 2008 July-2011 year in March in our hospital were treated with SAP according to whether there are subgroups of pancreatic infection were retrospectively analyzed,64 cases in the treatment group,SAP of early pancreatic infection patients, 139 cases of the control group,not complicated with pancreatic infection in patients with SAP,two groups of patients with treatment modalities,clinical characteristics were compared,and the impact of infection factors regression analysis. Results In the observation group,APACHE II and Ranson score significantly were higher than the control group,the serum Ca2+concentration was lower than that of the latter two groups index contrast,there was significant difference(P<0.05).The blood amylase,urine amylase and triglyceride index contrast has no obvious statistical difference between the two groups(P>0.05).The gastric tube in observation group was placed≥7d in patients with abdominal operation and the proportion of patients was significantly higher than that in control group(P<0.05),other treatment modalities compared between the two groups had no significant difference(P>0.05). APACHE II score,Ranson score,serum Ca2+concentration,placement of a gastrostomy tube≥7d and take abdominal operation is the impact of early SAP complicated with pancreatic infection risk factors. Conclusion The early stage of severe acute pancreatitis complicated with pancreatic infection is the major clinical manifestations of APACHE II score and Ranson score increased,blood Ca2+concentration decreased,while the effects of risk factors for infection with placement of a gastrostomy tube≥7d and take abdominal operation, so in patients with undiagnosed should pay close attention to APACHE II score,Ranson score and serum Ca2+concentration change gastrostomy tube placement,and shorten the time,active non operation therapy,to reduce pancreatic infection rate,improve the quality of life of patients.