摘要
目的 探讨高原重症急性胰腺炎（SAP）患者早期并发多脏器功能障碍综合征（MODS）的危险因素及治疗策略。方法 回顾性分析2000年1月-2002年12月及2003年1月-2005年12月分别收治的SAP患者108例和103例，前者为A组，后者为B组。对两组患者的年龄、性别、APACHEⅡ评分、是否伴有血液浓缩、休克、低氧血症、腹腔室隔综合征（ACS）、胸腔积液等因素进行Logistic分析，同时分析不同处理方式对SAP病死率的影响。结果 A组和B组中分别有33例和31例SAP患者早期并发MODS，这些患者在血液浓缩（HCT〉50％）、低氧血症、休克、ACS、胸腔积液方面明显高于无MODs的患者，差异有显著性（P〈0．01）。B组患者由于治疗策略转变，采用了早期液体足量复苏，早期机械通气，床边血液滤过，伴腹腔高压者早期行腹腔引流等，其病死率下降，与A组比较，差异有显著性（P〈0．01）。结论 高原地区SAP患者早期并发MODS的危险因素与血液浓缩、休克、低氧血症、ACS、胸腔积液以及与临床处理的方式有关。积极纠正低氧血症，液体足量复苏纠正休克和改善血液浓缩，控制炎症反应是阻止SAP早期发生MODS的关键。
Objective To explore risk factors and therapeutic strategies for severe acute pancreatitis （SAP） complicated with multi-organ dysfunction syndrome （MODS） in the early-stage at high altitudes. Methods Group A consisted of 108 SAP patients who were admitted from January 2000 to December 2002, and group B consisted of 103 SAP patients who were admitted from January 2003 to December 2005. Age, gender, acute physiology and chronic healthy score （APACHEⅡ ）, hemoconcentration, shock, hypoxia, abdomen compartment syndrome and pleural effusion were analyzed using logistic analysis. Risk factors affecting the mortality of SAP in terms of treatment were analyzed. Results 33 patients in group A and 31 patients in group B were complicated with MODS in the early stage. The conditions were more severe in patients with MODS than those in patients without MODS with regard to hemoconcentration. （HCT 〉 50%）, shock, hypoxia （PaO2 〈 50 mmHg）, abdomen compartment syndrome and pleural effusion, and the difference was significant （P 〈 0.01）. The mortality in group B was lower than that of group A because of changes in the therapeutic strategies including bedside CBP, mechanical ventilation and sufficient liquid resuscitation. Conclusions Hemoconcentration, shock, hypoxia, abdomen compartment syndrome, pleural effusion and strategy of clinical treatment are connected with SAP complicated with MODS in the early stage. Risk factors affecting high altitude SAP complicated MODS in the early stage include hypoxia, shock, hemoconcentration and strategy of clinical management. Positive correction of hypoxia, sufficient fluid resuscitation, improvement of hemoconcentration and inflammation control is the crux of preventing MODS in early SAP.
出处
《胰腺病学》
2007年第1期6-8,共3页
Chinese JOurnal of Pancreatology
基金
青海省科技厅资助项目（2002-N-122）
关键词
胰腺炎
急性坏死性
多器官功能衰竭
死亡率
高原
Pancreatitis, acute necrotizing
Multiple organ fallure
Mortality
High altitude
