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目的研究重症急性胰腺炎(severe acute pancreatitis,SAP)病人急性肾功能衰竭(acute renal failure,ARF)发生的易患因素,估价ARF与SAP病人预后的相关性,探讨预防ARF发生的措施。方法回顾性分析我院1990年以来收治的SAP病人246例,对病人年龄、性别、病因、Ranson评分、APACHEⅡ评分、低氧血症、腹腔室隔综合征、感染、血淀粉酶水平、尿淀粉酶水平、急诊手术、禁食天数、是否应用生长抑素等因素,进行多因素Logistic回归分析。结果246例SAP病人31例发生ARF,ARF的发病率为12.6%。ARF组APACHEⅡ评分明显高于无ARF组,两组比较有显著性差异。腹腔室隔综合征、低氧血症和急诊手术在两组之间比较有显著性差异。结论在SAP发病过程中,APACHEⅡ评分增高、低氧血症和腹腔室隔综合征可能是导致ARF发生的危险因素。维持病人全身状态稳定、防止肾脏低灌注损害、预防低氧血症的发生以及手术引流腹腔减压可能有预防ARF发生的作用。
Objective To study the risk factors of acute renal failure (ARF) in patients with severe acute pancreatitis (SAP) and to evaluate the correlation between ARF and the prognosis of SAP patients and to explore the preventive measures for ARF. Methods A retrospective analysis of 246 patients with SAP who were admitted to our hospital from 1990 to 1990 was conducted. The patients’ age, gender, etiology, Ranson score, APACHEⅡscore, hypoxemia, abdominal compartment syndrome, infection, blood amylase, Enzyme level, emergency surgery, fasting days, the use of somatostatin and other factors, multivariate Logistic regression analysis. Results The ARF occurred in 246 cases of SAP patients and the incidence of ARF was 12.6%. APACHE Ⅱ score in ARF group was significantly higher than that in no ARF group, there was significant difference between the two groups. Abdominal compartment syndrome, hypoxemia and emergency surgery in the two groups were significantly different. Conclusion In the process of SAP onset, APACHEⅡscore increased, hypoxemia and abdominal compartment syndrome may be the risk factors of ARF. Maintaining the patient’s stable systemic condition, preventing renal hypoperfusion damage, preventing the occurrence of hypoxemia and surgical drainage of abdominal decompression may have the effect of preventing ARF.