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目的对重症急性胰腺炎(SAP)早期肠功能障碍对后期胰腺感染的影响进行分析探讨,为临床诊治提供帮助。方法选取2012年1月至2016年1月收治的SAP患者110例为研究对象,其中后期继发胰腺感染的患者56例,设为观察组,未发生胰腺感染的患者54例,设为对照组。所有患者均存在早期肠道功能障碍。对两组患者的一般资料、临床症状、肠功能障碍持续时间及其他指标进行相关性分析。结果观察组患者APACHEⅡ评分、Ranson评分、血钙、血清淀粉酶及肠道功能障碍时间>5 d的发生率与对照组比较均有统计学差异(P<0.05,P<0.01),而尿淀粉酶和甘油三酯水平两组比较无统计学差异(P均>0.05)。两组患者低氧血症、呼吸机应用、肾功能衰竭情况比较有统计学差异(P<0.05,P<0.01)。多变量Logistic回归分析结果显示,患者就诊时的APACHEⅡ评分、Ranson评分、血钙和血清淀粉酶水平、低氧血症、呼吸机使用时间≥5 d、肾功能衰竭及肠功能障碍时间≥5d是胰腺炎感染的危险因素(P<0.05,P<0.01)。结论 SAP患者治疗中存在多种易感因素,较高的APACHEⅡ评分、Ranson评分等均易诱发SAP患者胰腺感染,早期肠功能障碍是导致胰腺后期发生感染的重要原因,临床采取针对性的治疗措施,对降低胰腺感染率具有重要意义。
Objective To analyze the effects of early intestinal dysfunction in patients with severe acute pancreatitis (SAP) on pancreatic infection in the late stage, and to provide help for clinical diagnosis and treatment. Methods From January 2012 to January 2016, 110 SAP patients were enrolled in this study. Among them, 56 patients with secondary pancreatic infection in the later stage were selected as observation group and 54 patients without pancreas infection as control group . All patients had early intestinal dysfunction. The two groups of patients with general information, clinical symptoms, intestinal dysfunction duration and other indicators were analyzed. Results The incidence of APACHEⅡscore, Ranson score, serum calcium, serum amylase and intestinal dysfunction time> 5 days in observation group were significantly different from those in control group (P <0.05, P <0.01) Enzyme and triglyceride levels between the two groups showed no significant difference (P> 0.05). The two groups of patients with hypoxemia, ventilator application, renal failure were statistically significant (P <0.05, P <0.01). Multivariate Logistic regression analysis showed that APACHEⅡscore, Ranson score, serum and serum amylase level, hypoxemia, ventilator use time≥5d, renal failure and intestinal dysfunction time≥5d were Risk factors for pancreatitis infection (P <0.05, P <0.01). Conclusion There are many susceptibility factors in the treatment of SAP patients. High APACHEⅡscore and Ranson score may induce pancreatic infection in patients with SAP. Early intestinal dysfunction is an important cause of late pancreatic infection, and targeted therapy , To reduce the rate of pancreatic infection is of great significance.