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目的探讨与重症急性胰腺炎(SAP)死亡相关的高危因素。方法回顾性分析2001年1月至2005年10月收治的141例 SAP 患者的临床资料。将患者分为死亡组和生存组,对可能影响 SAP 预后的15个因素采用 Logistic 回归分析。结果 141例 SAP 患者中死亡34例(24.1%)。死亡组患者在年龄、体重指数、住院时间、APACHEⅡ评分和并发多器官功能障碍综合征(MODS)、腹腔室隔综合征(ACS)等方面与生存组相比差异有统计学意义(P<0.05)。多因素分析显示,MODS(OR=67.358,P<0.01)、APACHEⅡ评分(OR=9.716,P<0.01)和 ACS(OR=5.775,P<0.05)是早期影响 SAP 预后的独立危险因素;胰腺感染(OR=9.652,P<0.01)、MODS(OR=5.212,P<0.05)和腹腔出血(OR=4.707,P<0.05)则是后期影响 SAP 预后的独立危险因素。结论 SAP 早期死亡的主要原因是 MODS,特别是呼吸功能障碍和肾功能障碍,而后期死亡的主要原因是感染、MODS 和腹腔出血。对高危因素进行早期预防和及时处理是降低 SAP 病死率的关键。
Objective To investigate the risk factors associated with the death of severe acute pancreatitis (SAP). Methods The clinical data of 141 patients with SAP admitted from January 2001 to October 2005 were retrospectively analyzed. Patients were divided into death and survival groups, and Logistic regression analysis was used for 15 factors that may affect the prognosis of SAP. Results Of 141 SAP patients, 34 died (24.1%). There was significant difference between the death group and the survival group in terms of age, body mass index, length of stay, APACHEⅡscore, MODS and ACS. ). Multivariate analysis showed that MODS (OR = 67.358, P <0.01), APACHEⅡscore (OR = 9.716, P <0.01) and ACS (OR = 5.775, P <0.05) were independent risk factors for early prognosis of SAP. (OR = 9.652, P <0.01). MODS (OR = 5.212, P <0.05) and intraperitoneal hemorrhage (OR = 4.707, P <0.05) were independent risk factors for later prognosis of SAP. Conclusions The main cause of early SAP death is MODS, especially respiratory dysfunction and renal dysfunction. The main causes of late death are infection, MODS and celiac hemorrhage. Early prevention of high-risk factors and timely treatment is the key to reduce SAP mortality.