Risk factors and prognosis analysis of severe acute pancreatitis complicated with abdominal compartment syndrome
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摘要:
目的 腹腔间隔室综合征是重症急性胰腺炎患者的常见、致死性并发症，可导致多脏器功能衰竭，并最终导致患者死亡，认识相关危险因素有利于早期防治腹腔间隔室综合征。本研究探讨重症急性胰腺炎并发腹腔间隔室综合征的危险因素及预后。 方法 回顾性收集2020年1月—2022年6月新疆医科大学第一附属医院收治的287例重症急性胰腺炎患者资料，根据是否发生腹腔间隔室综合征将患者分为腹腔间隔室综合征组(53例)和对照组(234例)，比较2组临床特征，采用多因素logistic回归分析探讨腹腔间隔室综合征的危险因素。 结果 与对照组比较，腹腔间隔室综合征组患者急性生理和慢性健康状况Ⅱ评分>10分的患者比例显著增加[54.72%(29例) vs. 39.32%(92例), P=0.040]；Ranson评分>4分的患者比例增加[59.62%(31例) vs. 42.74%(100例), P=0.027]；胰腺坏死感染比例增加[96.23%(51例) vs. 77.78%(182例), P=0.002]；多脏器功能衰竭比例增加[86.79%(46例) vs. 43.16%(101例), P < 0.001]；腹腔出血比例增加[20.75%(11例) vs. 9.40%(22例), P=0.019]；胆道感染比例增加[15.09%(8例) vs. 6.41%(15例), P=0.036]。胰腺坏死感染、多脏器功能衰竭、腹腔出血、胆道感染均为重症急性胰腺炎并发腹腔间隔室综合征的危险因素(P < 0.05)。腹腔间隔室综合征、胆道感染均为重症急性胰腺炎患者院内死亡的危险因素(P < 0.05)。 结论 胰腺坏死感染、多脏器功能衰竭、腹腔出血、胆道感染与重症急性胰腺炎并发腹腔间隔室综合征有关，均为预后不良的独立危险因素。 Abstract:Objective Abdominal compartment syndrome is a common and fatal complication in patients with severe acute pancreatitis, which can lead to multiple organ failure and ultimately result in death. Understanding the relevant risk factors is beneficial for early prevention and treatment of abdominal compartment syndrome. The aim of the present study was to explore the risk factors and prognosis of abdominal compartment syndrome in severe acute pancreatitis patients. Methods From January 2020 to June 2022, 287 patients with severe acute pancreatitis admitted to the First Affiliated Hospital of Xinjiang Medical University were retrospectively collected. Based on whether the patients developed abdominal compartment syndrome or not, they were divided into the abdominal compartment syndrome group (n=53) and the control group (n=234). The differences in clinical characteristics between the two groups were compared, and multivariate logistic regression analysis was used to explore the risk factors of abdominal compartment syndrome. Results Compared with the control group, the proportion of patients with an APPACHE Ⅱ score>10 in the abdominal compartment syndrome group significantly increased [54.72% (29 cases) vs. 39.32% (92 cases), P=0.040]; The proportion of Ranson scores>4 increased [59.62% (31 cases) vs. 42.74% (100 cases), P=0.027]; The proportion of pancreatic necrosis and infection increased [96.23% (51 cases) vs. 77.78% (182 cases), P=0.002]; The proportion of multiple organ failure increased [86.79% (46 cases) vs. 43.16% (101 cases), P < 0.001]; The proportion of abdominal bleeding increased [20.75% (11 cases) vs. 9.40% (22 cases), P=0.019]; The proportion of biliary tract infections increased [15.09% (8 cases) vs. 6.41% (15 cases), P=0.036]. Pancreatic necrosis infection, multiple organ failure, abdominal bleeding, and biliary tract infection were risk factors for abdominal compartment syndrome in severe acute pancreatitis patients (P < 0.05). Abdominal compartment syndrome and biliary tract infection were risk factors for hospital death in patients with severe acute pancreatitis (P < 0.05). Conclusion Pancreatic necrosis infection, multiple organ failure, abdominal bleeding, and biliary tract infection are associated with abdominal compartment syndrome, which is an independent risk factor for poor prognosis in patients with severe acute pancreatitis. -
Key words:
- Severe acute pancreatitis /
- Abdominal compartment syndrome /
- Mortality
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表 1 2组重症急性胰腺炎患者临床特征比较[例(%)]
Table 1. Comparison of clinical characteristics between two groups of patients with severe acute pancreatitis[cases (%)]
项目 腹腔间隔室综合征组(n=53) 对照组(n=234) χ2值 P值 年龄 2.950 0.086 >65岁 15(28.30) 96(41.03) ≤65岁 38(71.70) 138(58.97) 性别 0.172 0.679 男性 32(60.38) 134(57.26) 女性 21(39.62) 100(42.74) 病因 0.307 0.580 胆源性 33(62.26) 136(58.12) 非胆源性 20(37.74) 98(41.88) APPACHE Ⅱ评分 4.203 0.040 >10分 29(54.72) 92(39.32) ≤10分 24(45.28) 142(60.68) Ranson评分 4.884 0.027 >4分 31(59.62) 100(42.74) ≤4分 21(40.38) 134(57.26) 胰腺坏死感染 9.628 0.002 是 51(96.23) 182(77.78) 否 2(3.77) 52(22.22) 多脏器功能衰竭 32.923 < 0.001 是 46(86.79) 101(43.16) 否 7(13.21) 133(56.84) 腹腔出血 5.473 0.019 是 11(20.75) 22(9.40) 否 42(79.25) 212(90.60) 胆瘘 2.433 0.119 是 4(7.55) 7(2.99) 否 49(92.45) 227(97.01) 胆道感染 4.421 0.036 是 8(15.09) 15(6.41) 否 45(84.91) 219(93.59) 
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表 2 重症急性胰腺炎并发腹腔间隔室综合征的危险因素分析
Table 2. Analysis of risk factors for abdominal compartment syndrome in severe acute pancreatitis
变量 B SE Waldχ2 P值 OR值 95% CI 胰腺坏死感染 1.610 0.767 4.411 0.036 5.003 1.114~22.479 多脏器功能衰竭 2.180 0.436 25.048 < 0.001 8.849 3.768~20.783 腹腔出血 1.092 0.469 5.423 0.020 2.979 1.189~7.467 胆道感染 1.029 0.534 3.706 0.048 2.797 1.031~7.973 注：胰腺坏死感染、多脏器功能衰竭、腹腔出血、胆道感染赋值为是=1，否=0；并发腹腔间隔室综合征为是=1，否=0。本表仅列出差异有统计学意义的结果。
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表 3 2组重症急性胰腺炎患者临床干预情况和院内死亡率比较[例(%)]
Table 3. Comparison of clinical interventions and in-hospital mortality rates between groups of patients with severe acute pancreatitis [cases (%)]
项目 腹腔间隔室综合征组(n=53) 对照组(n=234) χ2值 P值 清创引流 0.919 0.338 是 53(100.00) 230(98.29) 否 0 4(1.71) 开腹手术 27.049 < 0.001 是 16(30.19) 14(5.98) 否 37(69.81) 220(94.02) 机械通气 7.748 0.005 是 35(66.04) 105(44.87) 否 18(33.96) 129(55.13) 持续血液滤过 14.448 < 0.001 是 40(75.47) 109(46.58) 否 13(24.53) 125(53.42) 血管活性药物 7.408 0.006 是 37(69.81) 115(49.15) 否 16(30.19) 119(50.85) 院内死亡 26.396 < 0.001 是 24(45.28) 33(14.10) 否 29(54.72) 201(85.90)
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表 4 重症急性胰腺炎患者院内死亡的危险因素分析
Table 4. Analysis of risk factors for in-hospital mortality in patients with severe acute pancreatitis
变量 B SE Waldχ2 P值 OR值 95% CI 腹腔间隔室综合征 1.553 0.339 20.976 < 0.001 4.724 2.431~9.181 胆道感染 1.086 0.480 5.107 0.024 2.961 1.155~7.593 注：腹腔间隔室综合征、胆道感染赋值为是=1，否=0；院内死亡，是=1，否=0。本表仅列出差异有统计学意义的结果。
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