Department of Emergency, Hunan Provincial People's Hospital, Changsha 410002, China.
J Crit Care. 2010 Jun;25(2):225-9. doi: 10.1016/j.jcrc.2009.07.009. Epub 2009 Sep 24.
Acute renal failure (ARF) is one of the most common causes of death in patients with severe acute pancreatitis (SAP). Here, we aimed to investigate the risk factors of ARF in patients with SAP, assess the prognosis of patients with SAP and ARF, and seek potential measures to prevent ARF.
A cross-sectional study was performed to analyze the data from patients with SAP. Both univariate and multivariate logistic regression analyses were performed, including 15 indices such as age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, abdominal compartment syndrome (ACS), and others. Univariate analysis was also used to compare the prognosis between the groups of patients with SAP with and without ARF.
There was a significant difference in age, history of renal disease, Acute Physiology and Chronic Health Evaluation II scores, hypoxemia, and ACS between the groups with and without ARF. Patients with SAP and ARF had significantly longer average length of stay and intensive care unit length of stay and higher infection rate of the pancreas and mortality rate.
The significant risk factors for ARF in patients with SAP include history of renal disease, hypoxemia, and ACS. Measures that can prevent ARF include homeostasis maintenance, adequate perfusion of the kidneys, adequate oxygenation, and abdominal decompression to avoid ACS.
急性肾衰竭(ARF)是重症急性胰腺炎(SAP)患者死亡的最常见原因之一。本研究旨在探讨 SAP 患者发生 ARF 的危险因素,评估 SAP 合并 ARF 患者的预后,并寻找预防 ARF 的潜在措施。
采用横断面研究分析 SAP 患者的数据。进行单因素和多因素 logistic 回归分析,包括年龄、肾脏病病史、急性生理学与慢性健康状况评分系统 II 评分、低氧血症、腹腔间室综合征(ACS)等 15 项指标。采用单因素分析比较 SAP 患者合并和不合并 ARF 的预后。
合并 ARF 与不合并 ARF 的两组患者在年龄、肾脏病病史、急性生理学与慢性健康状况评分系统 II 评分、低氧血症和 ACS 方面存在显著差异。SAP 合并 ARF 患者的平均住院时间、重症监护病房住院时间以及胰腺感染率和死亡率均显著较高。
SAP 患者发生 ARF 的显著危险因素包括肾脏病病史、低氧血症和 ACS。预防 ARF 的措施包括维持内环境平衡、肾脏充分灌注、充分氧合和腹部减压以避免 ACS。