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目的评价综合治疗重症急性胰腺炎(SAP)疗效,分析疗效影响因素,总结治疗经验。方法 84例SAP患者,给予中医药内科、西医内科、腹腔灌洗引流等综合治疗,据患者预后,分为死亡组(24例)和存活组(60例),进行因素分析。结果存活组年龄(43.8±12.0)岁低于死亡组(57.3±14.6)岁,病程(3.6±4.1)d长于死亡组的(1.7±1.2)d,差异均具有统计学意义(P<0.05)。存活组入院24 h尿量(1384.2±630.5)ml、Ranson评分(5.8±1.2)分、入院48 h急性生理学及慢性健康状况评分(APACHEⅡ评分)(7.9±4.3)分、血白蛋白(33.3±5.6)U/L、尿素氮(6.7±3.4)mmol/L、肌酐(88.6±44.2)μmol/L、血淀粉酶恢复正常时间(3.3±1.1)d与死亡组(976.7±630.3)ml、(6.8±1.1)分、(14.8±6.3)分、(29.3±5.6)U/L、(16.2±9.1)mmol/L、(256.2±220.1)μmol/L比较差异具有统计学意义(P<0.05);尿素氮、年龄、血白蛋白成为独立影响因素。结论 SAP死亡风险较高,死亡与高龄、营养不良、急性肾损伤密切相关,需做好营养管理、关注老年患者积极保护器官、监测尿量。
Objective To evaluate the efficacy of comprehensive treatment of severe acute pancreatitis (SAP), analyze the influencing factors and summarize the experience of treatment. Methods A total of 84 patients with SAP were divided into two groups: death group (24 cases) and survival group (60 cases), according to the prognosis of Chinese medicine, Western medicine and internal medicine, and peritoneal lavage and drainage. Results The survival time of the survivors was significantly lower than that of the deceased (57.3 ± 14.6) years and (3.6 ± 4.1) days, respectively, compared with that of the deceased (1.7 ± 1.2) days (43.8 ± 12.0) . In the surviving group, the urinary output (1384.2 ± 630.5) ml, Ranson score (5.8 ± 1.2), APACHEⅡ score of 48 h after admission (7.9 ± 4.3) and serum albumin (33.3 ± (6.7 ± 3.4) mmol / L, creatinine (88.6 ± 44.2) μmol / L, blood amylase recovery time (3.3 ± 1.1) d and death group (976.7 ± 630.3) ml, (P <0.05). The difference was statistically significant (P <0.05). The difference was statistically significant (P <0.05) ; Urea nitrogen, age, serum albumin became independent influencing factors. Conclusions The risk of SAP death is high. The death is closely related to the elderly, malnutrition and acute kidney injury. Nutrient management should be done. The elderly patients should be actively protected and their urine output monitored.