【摘要】：目的：分析重癥急性胰腺炎(severe acute pancreatitis, SAP)死亡的危險因素和建立危險因素的風(fēng)險模型。 方法：回顧性分析遵義醫(yī)學(xué)院附屬醫(yī)院2006年1月至2011年12月收治患者269例SAP的臨床資料,根據(jù)預(yù)后分為存活組234人與死亡組35人,采用單因素分析的方法,比較SAP患者一般資料、職業(yè)、誘因、病因、生化檢驗、初發(fā)型與復(fù)發(fā)型及是否手術(shù)在存活組和死亡組中的差異。篩選出有統(tǒng)計學(xué)差異的自變量,采用多因素Logistic回歸的方法,分析SAP獨立危險因素,建立危險因素的風(fēng)險模型,并對風(fēng)險模型進行評價。 結(jié)果：(1)存活組和死亡組年齡、心率、呼吸、血氧飽和度、白細(xì)胞、血清淀粉酶、尿素氮、肌酐、第一個24h排便量及排便次數(shù)、CTSI評分、APACHE Ⅱ評分(≤48h)、ARDS、SIRS、MODS、胰周包裹性積液、胰性腦病、腹腔間隔室綜合征、高血壓病史有統(tǒng)計學(xué)差異((P＜0.05)。多因素Logistic回歸顯示ARDS、MODS、尿素氮(BUN)、 APACHE Ⅱ評分是SAP患者死亡的獨立危險因素。(2)建立SAP的風(fēng)險模型,其靈敏度為97.9%,特異度為91.4%,陽性預(yù)測值為98.7%,陰性預(yù)測值為86.5%；一致性的檢驗統(tǒng)計量Kappa=0.872,有統(tǒng)計學(xué)意義(P＜0.01)；ROC曲線下面積(area under curve, AUC)為0.946。 結(jié)論：ARDS、MODS、尿素氮(BUN)和APACHE Ⅱ(≤48h)評分是SAP患者死亡的獨立危險因素。該風(fēng)險預(yù)測模型在一定程度上可對SAP患者的預(yù)后做出判斷。
[Abstract]:Objective: to analyze the risk factors and risk models of (severe acute pancreatitis, SAP) death in severe acute pancreatitis. Methods: the clinical data of 269 patients with SAP in the affiliated Hospital of Zunyi Medical College from January 2006 to December 2011 were retrospectively analyzed. According to the prognosis, the patients were divided into survival group (234 cases) and death group (35 cases). To compare the differences of general data, occupation, inducement, etiology, biochemical test, initial onset and recurrence, and whether or not the operation was performed between the survival group and the death group in SAP patients. The independent variables with statistical difference were screened out and the independent risk factors of SAP were analyzed by multivariate Logistic regression method. The risk model of risk factors was established and the risk model was evaluated. Results: (1) Age, heart rate, respiration, oxygen saturation, white blood cell, serum amylase, urea nitrogen, creatinine, first 24 h defecation volume and defecation times, CTSI score, APACHE 鈪，

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