中国实用外科杂志

中国实用外科杂志

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危重型急性胰腺炎进一步分型价值研究

韦    琴，申鼎成，宁彩虹，李嘉荣，林嘉晏，张    韬，陈    璐，朱    帅，黄耿文   

  1. 中南大学湘雅医院胰腺外科，湖南长沙 410008
  • 出版日期:2022-02-01

  • Online:2022-02-01

摘要： 目的    探讨危重型急性胰腺炎（CAP）进一步分型的价值。方法    回顾性分析2010年1月至2021年2月中南大学湘雅医院胰腺外科收治的120例CAP病人的临床资料。根据CAP病人器官功能衰竭和感染性胰腺坏死是否同期发生，分为同时性CAP（69例）和异时性CAP（51例）两组，比较两组病人临床结局的差异。结果    全组病死率为42.5%（51/120），其中同时性CAP病死率为66.7%（46/69），高于异时性CAP组（9.8%，5/51），差异具有统计学意义（P<0.05）。与异时性CAP相比，同时性CAP病人多器官功能衰竭发生率更高、器官功能衰竭持续时间更长、术后出血发生率更高、ICU住院时间及总的住院时间明显延长（均P<0.05）。多因素Logistic回归分析显示，起病至IPN时间（OR=1.1，95%CI 1.0-1.2，P=0.010）、多器官功能衰竭（OR=8.3，95%CI 2.1-32.2，P=0.002）和同时性CAP（OR=9.4，95%CI 2.6-34.5，P=0.001）是CAP病人死亡的独立预后因素。结论    同时性CAP是早期器官功能衰竭进行的同时并发感染性胰腺坏死，预后极差。对CAP做进一步分型有助于指导对其预后判断和治疗方式的选择。

关键词: 急性胰腺炎, 危重型胰腺炎, 器官功能衰竭, 感染性胰腺坏死

Abstract: The value of further classification of critical acute pancreatitis        WEI Qin, SHEN Ding-cheng, NING Cai-hong, et al. Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Corresponding author: HUANG Geng-wen, E-mail:huanggengwen@csu.edu.cn
Abstract    Objective    To investigate the value of further classification of critical acute pancreatitis (CAP). Methods   A cohort of 120 patients with CAP at Xiangya Hospital, Central South University from January 2010 to February 2021 was retrospectively analyzed. CAP was classified as synchronous CAP group（n=69）and metachronous CAP group (n= 51) depending on whether organ failure and infected pancreatic necrosis occurred in the same period. The clinical outcomes were compared between these two groups. Results    The mortality rate was 42.5% (51/120) in the whole group. The mortality rate in patients with synchronous CAP (66.7%, 46/69) was significantly higher than that in metachronous CAP group (9.8%, 5/51) (P<0.05). Compared with metachronous CAP, synchronous CAP had a significantly higher incidence of multiple organ failure, longer duration of organ failure, higher incidence of bleeding complications, and longer ICU stay and total length of stay (all P< 0.05). Multivariate analysis of death predictors indicated that onset to IPN（OR=1.1, 95%CI 1.0-1.1, P=0.01），multiple organ failure (MOF)（OR=8.3,95%CI 2.1-32.2, P=0.002）、synchronous CAP（OR=9.4, 95%CI 2.6-34.5, P=0.001） were significant prognostic factors in CAP patients. Conclusion    Synchronous CAP, when early organ failure and infected pancreatic necrosis occurred in the same period, was characterized with fatal outcomes. Further classification of CAP would help to guide the prognosis judgement and treatment choice.

Key words: acute pancreatitis, critical pancreatitis, organ failure, infected pancreatic necrosis