老年重症急性胰腺炎患者死亡风险分析

Risk factors for mortality among elderly patients with severe acute pancreatitis

摘要:

分析老年重症急性胰腺炎(SAP)患者住院期间死亡的相关因素。方法 回顾性分析2015年1月至2019年12月解放军总医院第一医学中心肝胆外科胰腺炎专病中心收治的314例SAP患者的临床资料。按年龄分为老年组(≥60岁)和非老年组(＜60岁),比较2组患者病情及预后情况。对老年组患者,按是否死亡分为老年死亡组和老年生存组,比较2组患者的差异及分析死亡相关因素。采用R Studio. Inc. Version 1.1.456软件进行数据分析。采用Wilcoxon符号秩检验和χ²检验进行组间比较,采用logistic回归分析老年SAP患者死亡的相关因素。结果 老年组患者比非老年组患者死亡率显著升高(34.5% 和 16.9%),ICU治疗时间更长[2(0,11)和6(1,15)d],接受外科治疗比例(73.6%和58.2%)和接受胰周坏死组织清除手术的次数较少,接受呼吸(60.0%和32.4%)、循环支持(58.2%和32.4%)的患者比例更高。对于老年SAP患者,年龄和肾脏功能衰竭需要给予肾脏替代治疗为死亡的独立风险因素。结论 老年患者罹患SAP预后差,应格外关注重要器官功能的维护。

Abstract:

Objective To investigate the related factors for in-hospital mortality in elderly patients with severe acute pancreatitis (SAP). Methods Clinical data of 314 SAP patients admitted to the Center for Pancreatitis, Department of Hepatobiliary Surgery in the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2019 were retrospectively collected and analyzed. The patients were divided into aged group (≥60 years) and non-aged group (<60 years). Their conditions and prognosis were compared between 2 age groups. For the aged group, they were further assigned into death subgroup and survival subgroup. The differences were compared and the related factors for mortality were analyzed. R Studio. Inc. Version 1.1.456 was used to make statistical analysis. Wilcoxon test and Chi-square test were adopted for intergroup comparison, and logistic regression analysis was employed to analyze the related factors for death in the elderly SAP patients. Results The aged group had significantly higher mortality rate (34.5% vs 16.9%), longer length of ICU stay[2(0,11) vs 6(1,15)d], higher surgical intervention rate (73.6% vs 58.2%), and fewer undergoing necrosectomies, and larger proportion of respiratory (60.0% vs 32.4%) and circulation supports (58.2% vs 32.4%) when compared with the non-aged group. For the elderly SAP patients, age and requiring renal replacement due to renal failure were independent risk factors for in-hospital mortality. Conclusion The elderly SAP patients have poor prognosis. Special attention should be paid to them for the support of vital organ function.