摘要
目的探讨急性坏死性胰腺炎患者经皮胰腺或胰腺周围穿刺引流术相关风险因素。方法回顾性分析南昌大学第二附属医院2009年1月-2015年12月收治经临床确诊的急性坏死性胰腺炎患者共50例。分为好转组和恶化组。好转组在急性胰腺炎合并坏死行经皮胰腺或胰腺周围穿刺引流术(Percutaneous Catheter Drainage,PCD)后好转出院共26例,恶化组在急性胰腺炎合并坏死行PCD后症状无缓解或加重最终导致放弃治疗或死亡的24例。比较2组患者在不同年龄、病因、性别,穿刺培养微生物、药敏、MCTSI评分、NJSS评分、APACHEII评分、BISAP评分、是否合并全身反应综合征(systemic inflammatory response syndrome,SIRS)、实验室检查及其他风险因素的作用下的经皮胰腺或胰腺周围穿刺引流术效果以及检验四种评分系统在穿刺前及入院时对预后的评估价值。结果患者多重微生物感染是穿刺失败的风险因素。感染微生物多重耐药及是否合并SIRS并不是穿刺失败的风险因素;MCTSI评分、NJSS评分、APACHEII评分、BISAP评分是穿刺的风险因素,穿刺前评测优于入院时;穿刺前MCTSI评分的AUC为0.923(P=0,95%,CI:0.847-0.999)、最佳阈值7、约登指数0.712、OR:21.9。结论患者在出现多重微生物感染或微生物呈全耐药菌提示预后不佳;四种评分系统在一定程度上均可预测患者预后。APACHEII评分、BISAP评分、NJSS评分、MCTSI评分穿刺前评估优于入院时。MCTSI评分总体优于其他三种评分。
Objective To analyze the risk factors for failure of PCD for the patients with acute necrotizing pancreatitis. Methods 50 cases of ANP patients in our hospital from January 2009 to December 2015 were divided into the improved group and the deterioration group. A total of 26 ANP patients after PCD were improved. A total of 24 cases in deterioration group after PCD were not remission or exacerbation and finally gave up treatment or finally death. Collection and comparison the effect of the two groups with different ages, etiology, sex, microorganism, drug sensitivity, MCTSI, NJSS, APACHE II, BISAP, SIRS and other risk factors and the predictive value of those four kinds of scoring systems before puncture and on admission. Results Multiple microbial infection is the risk factors of puncture failure. Microbial infection with multi drug resistance and amylase and SIRS are not the risk factors of puncture failure;MCTSI, NJSS, APACHEII, BISAP are the risk factors of puncture. Before puncture ,the value is better than that on admission;MCTSI before puncture,AUC is 0.923 （P=0,95%,CI：0.847-0.999 7）,the best threshold value is 7,youden index is 0.712,OR：21.9. Conclusion Patients with multiple microbial infection or with PDR indicate poor prognosis ;Four scoring systems can predict the prognosis of patients to a certain extent. Before puncture,the value is better than that on admission. MCTSI is better than the others.
作者
吴洌
邹书兵
WU Lei ZHOU Shubing(Shangrao People＇ s Hospital, Shangrao, Jiangxi, 334000, China the Second Affiliated Hospital of Nanehang University, Nanchang , 330006, ChinA)
出处
《江西医药》
CAS
2017年第5期384-389,共6页
Jiangxi Medical Journal
关键词
急性坏死性胰腺炎
经皮穿刺引流术
风险因素
Acute necrotizing pancreatitis
Pereutaneous catheter drainage
Risk factors
