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目的探讨暴发性胰腺炎(FP)早晚期死亡原因。方法将本中心2000~2010年收治的92例FP中死亡的55例患者,按死亡时间分成早期组(7 d内死亡)和晚期组(7 d后死亡),对其24 h急慢性生理评分Ⅱ(APACHEⅡ),并发症及其发生时间,以及感染部位和菌群进行对比分析。结果 FP的病死率为59.8%(55/92例),其中,20.6%(19例)3 d内死亡,29.3%(27例)14 d后死亡。早期组24 h APACHEⅡ评分及血清甘油三酯高于对照组(P<0.05);肾功能衰竭休克、急性肝损伤、脑病、消化道出血及感染的发生时间早于晚期组(P<0.05);晚期组脑病、消化道出血及胰腺坏死感染的发生率高于早期组(P<0.05),感染以革兰氏阴性菌为主。结论 FP主要死于早期全身炎性反应综合征及后期感染引起的多器官衰竭,感染主要以革兰氏阴性菌为主。
Objective To investigate the causes of early and late death in patients with fulminant pancreatitis (FP). Methods Fifty-five of 92 FP patients who were admitted to our center from 2000 to 2010 were divided into early stage (within 7 days) and late stage (after 7 days) according to the time of death, and their 24 h acute and chronic physiological scores Ⅱ (APACHE Ⅱ), complication and its time, as well as the infection site and flora were analyzed. Results The mortality of FP was 59.8% (55/92 cases). Among them, 20.6% (19 cases) died within 3 days and 29.3% (27 cases) died after 14 days. The APACHE Ⅱ score and serum triglyceride level in the early group at 24 h were higher than those in the control group (P <0.05). The incidence of renal failure, acute liver injury, encephalopathy, gastrointestinal bleeding and infection were earlier than those in the late group (P <0.05). The incidence of encephalopathy, gastrointestinal bleeding and pancreatic necrosis in advanced stage was higher than that in early stage (P <0.05). Gram-negative bacteria were the main infection. Conclusion FP mainly died of early systemic inflammatory response syndrome and multiple organ failure caused by later infection. The main infection was Gram-negative bacteria.