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目的:探讨重症急性胰腺炎早期死亡的预测因素。方法:回顾性分析93例重症急性胰腺炎患者完整病例资料,依据早期死亡的定义将患者分为早期死亡组(35例)和早期生存组(58例),分析判断早期死亡的危险因素。结果:预测重症急性胰腺炎早期死亡危险因素主要包括剩余碱、血肌酐、血糖、谷草转氨酶和血钙。多因素分析显示剩余碱是预测早期死亡的独立危险因素(P=0.001)。剩余碱联合血肌酐评估,阳性预告为50%,与日本严重程度评分(JSS)对早期死亡评估相当。早期死亡患者均有胰腺坏死,且JSS≥15分。早期死亡患者的乳酸脱氢酶>1300u/L。结论:剩余碱是预测早期死亡的独立危险因素。剩余碱和肌酐联合对早期死亡患者评估效果与JSS相当。乳酸脱氢酶>1300u/L可能是早期死亡的危险因素之一。
Objective: To investigate the predictors of early death in severe acute pancreatitis. Methods: The data of 93 patients with severe acute pancreatitis were retrospectively analyzed. According to the definition of early death, the patients were divided into early death group (35 cases) and early survival group (58 cases), and the risk factors of early death were analyzed. Results: Predictors of early mortality in severe acute pancreatitis include residual alkali, serum creatinine, blood glucose, aspartate aminotransferase and serum calcium. Multivariate analysis showed that residual alkali was an independent risk factor for predicting early death (P = 0.001). Remaining base combined with serum creatinine assessment, positive predictive value was 50%, comparable to the Japan Death Sense (JSS) assessment of early death. Patients with early death have pancreatic necrosis, and JSS ≥ 15 points. Lactate dehydrogenase in patients with early death> 1300u / L. Conclusion: The residual alkali is an independent risk factor for predicting early death. Residual alkali and creatinine combined with early death assessment of patients with JSS equivalent. Lactate dehydrogenase> 1300u / L may be one of the risk factors of early death.