本文選題：急性胰腺炎 + 危險因素��； 參考：《華中科技大學(xué)》2014年博士論文

【摘要】：目的回顧性分析急性胰腺炎患者腹腔壓力的相關(guān)性臨床指標(biāo),給出腹腔內(nèi)壓力相關(guān)因素的線性回歸模型,探究急性胰腺炎合并腹腔間隔室綜合征的危險因素,以及對于腹腔間隔室綜合征的臨床治療策略及預(yù)后的相關(guān)性分析。 方法對武漢協(xié)和醫(yī)院胰腺外科2008年1月1日至2013年6月30日確診急性胰腺炎的完整住院病例共1135例進(jìn)行分析,其中記錄腹腔壓力且發(fā)病72小時入院的完整病例共210例納入回顧性分析。 結(jié)果1)210例患者中男性患者129例,占患者總數(shù)的61.4%,女性患者81例,占患者總數(shù)的38.6%；發(fā)病后24小時內(nèi)就診患者60例,24-48小時就診患者92例,48-72小時就診患者58例；膽源性胰腺炎101例,占患者總數(shù)的48.1%,酒精性胰腺炎28例,高脂血癥性胰腺炎30例。2)腹腔壓力(mmHg)單因素相關(guān)分析表明,P0.05的臨床指標(biāo)如下：BMI,相關(guān)系數(shù)0.193,P=0.005；白細(xì)胞計數(shù),相關(guān)系數(shù)0.217,P=0.002:APACHEⅡ評分,相關(guān)系數(shù)0.487,P=0.000；CT評分,相關(guān)系數(shù)0.524,P=0.000；血清白蛋白,相關(guān)系數(shù)-0.264,P=0.000；72h液體凈入量,相關(guān)系數(shù)0.222,P=0.000。3)進(jìn)一步腹腔壓力(mmHg)多因素相關(guān)分析,P0.05的臨床指標(biāo)如下,APACHEⅡ評分,偏相關(guān)系數(shù)0.442,P=0.000；CT評分,偏相關(guān)系數(shù)1.305,P=0.000；血清白蛋白,偏相關(guān)系數(shù)-0.255,P=0.000；72h液體凈入量,偏相關(guān)系數(shù)0.322,P=0.014；得出回歸模型：腹腔內(nèi)高壓危險指數(shù)=11.335+1.305*CT+0.442*APACHEⅡ-0.255*血清白蛋白+0.322*72h液體凈入量。此回歸方程可預(yù)測患者可能的腹腔壓力情況,判斷患者發(fā)生ACS的風(fēng)險,從而引起臨床醫(yī)生的關(guān)注。4)210例患者,發(fā)生ACS共69例,ACS組患者平均IAP為25.41±3.98mmHg,平均APP為58.41±6.29mmHg,未發(fā)生ACS共141例,非ACS組平均IAP為18.87±5.40mmHg,平均APP為67.27±4.33mmHg。5)分析ACS組患者治療與預(yù)后指標(biāo)的相關(guān)性,P0.05的治療指標(biāo)如下,是否行超聲引導(dǎo)下經(jīng)皮穿刺置管引流(PCD),偏相關(guān)系數(shù)-1.211,P=0.000；進(jìn)入負(fù)平衡時間,偏相關(guān)系數(shù)0.635,P=0.000。得到預(yù)后指數(shù)模型：ACS預(yù)后指數(shù)=5.23-1.211*是否行PCD+0.635*進(jìn)入負(fù)平衡時間。此模型認(rèn)為積極的開展PCD治療和綜合液體治療是ACS治療的關(guān)鍵點。 結(jié)論急性胰腺炎患者腹腔壓力與年齡、性別、病因等多項臨床指標(biāo)無相關(guān)性,與BMI、白細(xì)胞計數(shù)僅單因素相關(guān),與APACHE Ⅱ評分、CT評分、血清白蛋白和72h液體凈入量多因素相關(guān),并給出回歸模型：腹腔內(nèi)高壓危險指數(shù)=11.335+1.305*CT+0.442*APACHE Ⅱ.0.255*血清白蛋白+0.322*72h液體凈入量。此回歸方程可預(yù)測患者可能的腹腔壓力情況,判斷患者發(fā)生ACS的風(fēng)險,從而引起臨床醫(yī)生的關(guān)注。ACS組的腹腔壓力與非ACS組比較有明顯升高,腹腔灌注壓力明顯降低。行腹腔微創(chuàng)治療及積極使液體進(jìn)入負(fù)平衡對預(yù)后有積極意義,并給出預(yù)后指數(shù)模型：ACS預(yù)后指數(shù)=5.23-1.211*是否行PCD治療+0.635*進(jìn)入負(fù)平衡時間,此模型認(rèn)為積極的開展PCD治療和綜合液體治療是ACS治療的關(guān)鍵點,并應(yīng)針對各器官衰竭情況對癥治療。
[Abstract]:Objective to investigate the risk factors of acute pancreatitis complicated with abdominal septal syndrome by retrospectively analyzing the clinical parameters of abdominal pressure and establishing a linear regression model of the factors related to intraperitoneal pressure in patients with acute pancreatitis. And the correlation analysis of clinical treatment strategy and prognosis of abdominal septal syndrome. Methods from January 1, 2008 to June 30, 2013, a total of 1135 patients with acute pancreatitis diagnosed in the Department of Pancreatic surgery in Wuhan Union Union Hospital were analyzed. A total of 210 patients with abdominal pressure and 72-hour admission were included in the retrospective analysis. Results (1) there were 129 male patients (61.4%) in 210 patients, 81 female patients (38.6%), 60 cases (24 to 48 hours) within 24 hours after the onset of the disease, 92 cases (48-72 hours), 101 cases (101 cases) of biliary pancreatitis. The single factor correlation analysis of abdominal pressure (mmHg) in 28 cases of alcoholic pancreatitis and 30 cases of hyperlipidemic pancreatitis showed that the clinical indexes of P05 were as follows: BMI0.193, correlation coefficient 0.193, WBC count, correlation coefficient 0.217g, APACHE 鈪，

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