[暴发性胰腺炎的临床特征及预后因素]

[Clinical characteristics and prognostic factors of fulminate pancreatitis].

作者信息

Huang Li-Bin, Tang Cheng-Wei, Xie Yong-Mei, Zhang Jun, Wu Song-Ze

机构信息

Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2005 Jan;44(1):9-12.

PMID:15769388

Abstract

OBJECTIVE

To study the clinical characteristics of fulminate pancreatitis (FP) and analysis the factors related to prognosis of FP.

METHODS

Data of 203 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 2000 to December 2002 were reviewed. FP was defined as presence of organ dysfunction within 72 h after onset of symptoms. 78 patients had FP, 125 patients without organ dysfunction within 72 h after onset of symptoms had common severe acute pancreatitis (CSAP). The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between FP and CSAP were compared, then the factors related to prognosis of FP were analysed.

RESULTS

The incidences of T >/= 38.5 degrees C, hypoxemia, shock, white cell count >/= 16 x 10(9)/L, serum calcium < 2.0 mmol/L and multiple organ dysfunction syndrome (MODS) in FP were higher than those in CSAP (71.8% vs 39.2%, 83.3% vs 30.4%, 41.0% vs 12.0%, 64.1% vs 30.4%, 68.0% vs 44.8%, 73.1% vs 11.2%, P < 0.05). Impairment degree of pancreas (Balthazar CT severity index) in FP was more serious than that in CSAP (5.78 +/- 0.83 vs 3.12 +/- 0.57, P < 0.05). FP had a higher mortality than CSAP (44.9% vs 8.8%, P < 0.05). In multiple logistic regression analysis, the main predisposing factors to FP were hypoxemia, MODS and Balthazar CT severity index.

CONCLUSIONS

FP is characterised by severe systemic inflammatory response, severe pathological changes of pancreas, high incidence of MODS and high mortality. The main predisposing factors to FP were hypoxemia, MODS and Balthazar CT severity index.

摘要

目的

研究暴发性胰腺炎（FP）的临床特征并分析其预后相关因素。

方法

回顾性分析2000年1月至2002年12月期间我院收治的203例症状发作后72小时内入院的重症急性胰腺炎（SAP）患者的数据。FP定义为症状发作后72小时内出现器官功能障碍。78例患者为FP，125例症状发作后72小时内无器官功能障碍的患者为普通重症急性胰腺炎（CSAP）。比较FP和CSAP的临床特征、住院期间器官功能障碍的发生率及预后，然后分析FP预后的相关因素。

结果

FP患者中体温≥38.5℃、低氧血症、休克、白细胞计数≥16×10⁹/L、血清钙<2.0 mmol/L及多器官功能障碍综合征（MODS）的发生率高于CSAP（71.8%对39.2%、83.3%对30.4%、41.0%对12.0%、64.1%对30.4%、68.0%对44.8%、73.1%对11.2%，P<0.05）。FP患者胰腺的损伤程度（Balthazar CT严重程度指数）比CSAP更严重（5.78±0.83对3.12±0.57，P<0.05）。FP的死亡率高于CSAP（44.9%对8.8%，P<0.05）。多因素logistic回归分析显示，FP的主要诱发因素为低氧血症、MODS和Balthazar CT严重程度指数。