Block S, Büchler M, Bittner R, Beger H G
Department of General Surgery, University of Ulm, F.R.G.
Pancreas. 1987;2(5):499-505. doi: 10.1097/00006676-198709000-00002.
Twenty-one routine clinical and laboratory data in 161 patients with necrotizing pancreatitis (NP) undergoing surgical treatment were analyzed. The necrotic tissue at operation was bacterially infected in 41% of the patients. The goal of the study was to evaluate whether there was any special clinical feature in cases of an infection. The parameters were recorded during 48 h after admission as well as during 48 h before operation, and the frequencies submitted to both a univariate and a multivariate analysis (logistic regression model). In the period after admission, patients with infected necrosis significantly more often had a rectal temperature greater than 38.5 degrees C (p = 0.001). Before operation (i.e., after maximum conservative treatment), four findings were significantly related to an infection: rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, hematocrit less than 35% (all p = 0.0001), and paO2 less than 60 mm Hg (p = 0.001). The multivariate analysis, which calculates and quantifies the mutual influence of factors, showed a combination of three findings (rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, and hematocrit less than 35%) to be related to necrosis infection before operation. All three criteria in a patient imply a probability of infection of 83%. It is noteworthy that the sepsis indicators were equally distributed in patients with focal, extended, or subtotal/total infected necrosis, but correlated with the necrosis extent in sterile necrotizing pancreatitis. Moreover, all parameters not related to the pancreatic infection [e.g., hyperglycemia, hypocalcemia, rise of lactic dehydrogenase (LDH), and the white blood cell count] correlated with the three necrosis categories.
对161例接受手术治疗的坏死性胰腺炎（NP）患者的21项常规临床和实验室数据进行了分析。41%的患者手术时坏死组织存在细菌感染。本研究的目的是评估感染病例是否有任何特殊的临床特征。在入院后48小时以及手术前48小时记录各项参数，并将其频率进行单因素和多因素分析（逻辑回归模型）。在入院后的时间段内，感染性坏死患者直肠温度高于38.5℃的情况明显更常见（p = 0.001）。在手术前（即最大程度保守治疗后），有四项发现与感染显著相关：直肠温度高于38.5℃、碱剩余大于-4 mmol/L、血细胞比容低于35%（所有p = 0.0001）以及动脉血氧分压低于60 mmHg（p = 0.001）。计算并量化各因素相互影响的多因素分析显示，三项发现（直肠温度高于38.5℃、碱剩余大于-4 mmol/L以及血细胞比容低于35%）的组合与手术前坏死感染相关。患者具备所有这三项标准意味着感染概率为83%。值得注意的是，脓毒症指标在局灶性、广泛性或部分/全部感染性坏死患者中分布相同，但在无菌性坏死性胰腺炎中与坏死范围相关。此外，所有与胰腺感染无关的参数[如高血糖、低钙血症、乳酸脱氢酶（LDH）升高以及白细胞计数]均与三种坏死类型相关。
