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目的分析重症急性胰腺炎患者出现胰性脑病的临床特点并研究其预警因素。方法回顾性分析2010年7月—2015年7月本院脾胃肝胆科、ICU收治的140例重症急性胰腺炎患者作为研究对象,根据是否出现胰性脑病分为观察组和对照组各70例。对比分析两组临床特点,研究其预警因素。计量资料采用t检验,计数资料采用χ~2检验,对单因素分析差异有统计学意义的指标进一步做Logistic回归分析,P<0.05为差异有统计学意义。结果观察组病情恶化率为54.29%,高于对照组的28.57%,差异有统计学意义(P<0.05)。观察组急性生理学及慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、三酰甘油、肌酐水平分别为(22.37±10.05)分、(2.20±0.12)mmol/L、(173.47±24.67)μmol/L,对照组分别为(16.07±9.83)分、(0.70±0.06)mmol/L、(87.56±11.34)μmol/L,两组比较差异均有统计学意义(均P<0.05)。观察组真菌感染率、多器官功能衰竭(multiple organ dysfunction syndrome,MODS)发生率分别为30.00%、61.43%,对照组分别为11.43%、35.71%,两组比较差异均有统计学意义(均P<0.05)。APACHEⅡ评分(OR=2.910,95%CI为1.302~8.047)及三酰甘油(OR=3.011,95%CI为1.197~6.832)监测对于胰性脑病的发生具有预警作用。结论胰性脑病对于重症急性胰腺炎患者的预后具有不良影响,临床上主要表现为兴奋性症状,高APACHEⅡ评分及高三酰甘油血症是胰性脑病的预警因素。
Objective To analyze the clinical features of pancreatic encephalopathy in patients with severe acute pancreatitis and study its early warning factors. Methods A retrospective analysis was performed on 140 patients with severe acute pancreatitis admitted to the hospital from July 2010 to July 2015 in our hospital for spleen and stomach, hepatobiliary and ICU patients, and divided into observation group and control group according to whether there were 70 cases of encephalopathy. Comparative analysis of two groups of clinical features, to study the early warning factors. Measurement data using t test, count data using χ ~ 2 test, the single factor analysis was statistically significant indicators of further Logistic regression analysis, P <0.05 for the difference was statistically significant. Results The deterioration rate of observation group was 54.29%, which was higher than that of control group (28.57%), the difference was statistically significant (P <0.05). The acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), triglyceride and creatinine in the observation group were (22.37 ± 10.05), (2.20 ± 0.12) mmol / L and (173.47 ± 24.67) (16.07 ± 9.83), (0.70 ± 0.06) mmol / L and (87.56 ± 11.34) μmol / L respectively in the control group. The differences between the two groups were statistically significant (all P <0.05). The incidences of fungal infection and multiple organ dysfunction syndrome (MODS) in the observation group were 30.00% and 61.43%, respectively, which were 11.43% and 35.71% respectively in the control group, with significant differences between the two groups (P <0.05). APACHEⅡscore (OR = 2.910, 95% CI 1.302-8.047) and triglyceride (OR = 3.011, 95% CI 1.197-6.832) had an early warning effect on the occurrence of pancreatic encephalopathy. Conclusion Pancreatic encephalopathy has an adverse effect on the prognosis of patients with severe acute pancreatitis. The main clinical manifestations are excitatory symptoms, high APACHE Ⅱ score and hypertriglyceridemia are the early warning factors of pancreatic encephalopathy.