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目的 研究暴发性胰腺炎 (FP)的临床表现特点及影响其预后的相关因素。方法 回顾性研究 2 0 0 0年 1月 - 2 0 0 2年 12月我院收治的 2 0 3例重症急性胰腺炎 (SAP)患者。FP定义为发病 72h内出现器官功能障碍的SAP ,共 78例 ;余 12 5例SAP在发病 72h内未出现器官功能障碍 ,称为普通型SAP(CSAP) ,比较分析两组病人的临床特点 ,并分析FP死亡的相关因素。结果 FP组出现体温≥ 38 5℃、低氧血症、休克、白细胞计数≥ 16× 10 9/L、血清钙 <2 0mmol/L及多器官功能障碍综合征 (MODS)的百分率均明显高于CSAP组 (分别为 71 8%比 39 2 % ,83 3%比 30 4 % ,4 1 0 %比 12 0 % ,6 4 1%比 30 4 % ,6 8 0 %比 4 4 8% ,73 1%比 11 2 % ,P值均 <0 0 5 ) ;FP组胰腺BalthazarCT评分高于CSAP组 (5 78± 0 83比 3 12± 0 5 7,P <0 0 5 ) ;FP组病死率明显高于CSAP组 (44 9%比 8 8% ,P <0 0 5 )。死亡相关因素分析发现 ,低氧血症、MODS、胰腺病变程度与死亡有关 (P <0 0 5 )。结论 FP具有全身炎症反应重、胰腺病变程度严重、MODS发生率高、病死率高的临床特点 ;与FP死亡相关的因素有低氧血症、MODS及胰腺病变程度。
Objective To study the clinical features of fulminant pancreatitis (FP) and the related factors that influence its prognosis. Methods A retrospective study of 200 patients with severe acute pancreatitis (SAP) treated in our hospital from January 2000 to December 2002 was performed. FP was defined as organ dysfunction within 72 hours of onset of SAP, a total of 78 cases; more than 125 cases of SAP 72 hours in the onset of organ dysfunction did not appear, known as ordinary SAP (CSAP), comparative analysis of two groups of patients with clinical features, And analyze the related factors of FP death. Results The incidence of hypoxemia, shock, leukocyte count ≥ 16 × 10 9 / L, serum calcium <20 mmol / L and multiple organ dysfunction syndrome (MODS) in FP group were significantly higher than those in other groups CSAP group (71.8% vs. 39.2%, 83.3% vs. 30.4%, 41.0% vs. 120%, 64.1% vs. 30.4%, 68.0% vs. 448%, 73 1% vs 11.2%, P <0.05). The pancreatic Balthazar CT score in FP group was higher than that in CSAP group (578 ± 0 83 vs 312 ± 0 57, P <0 05) Significantly higher than CSAP group (44.9% vs. 88%, P <0 05). Mortality-related factor analysis found that hypoxemia, MODS, pancreatic lesions and death related (P <0 05). Conclusion FP has the characteristics of systemic inflammatory response, severe pancreatic lesions, high morbidity of MODS and high mortality rate. The factors associated with FP death are hypoxemia, MODS and pancreatic lesions.