【摘要】 目的分析重症急性胰腺炎(SAP)合并急性肾功能衰竭(ARF)的临床特点及其预防和治疗。方法回顾分析南京军区南京总医院1997年1月至2005年4月收治的503例SAP中合并ARF的54例病人的临床资料,并用直线回归(逐步回归)方法,对影响SAP合并ARF的发生率及病死率的相关因素进行分析。结果SAP合并ARF的发生率为10·7%,病人的年龄、SIRS(全身炎症反应综合征)持续时间、病情严重程度(APACHEⅡ评分、CT评分)、ARDS(急性呼吸窘迫综合征)、MODS(多器官功能障碍综合征)、ACS(腹腔间室综合征)、感染及局部并发症等因素对ARF的发生有显著的影响;54例中,死亡18例(33·3%),同时合并ARDS和MODS是增加病人病死率的重要原因。是否伴有胰周感染对病人的病死率影响不显著。结论早期液体复苏、控制病情发展、维护重要脏器功能及积极有效的引流是预防SAP并发ARF,改善预后的重要手段。更多还原

【Abstract】 Objective To analyse the clinic characteristics of acute renal failure (ARF) complicating severe actue pancreatitis(SAP),and study the methods of prevention and therapy of it.Methods 503 patients with SAP who were in hospital between Jan.1997 and Apr.2005 and 54 of whom were complicated with ARF were retrospectively analyzed to conclude the morbility and mortality from ARF complicating SAP,then analyze the impact factors of them respectively by linear regression (stepwise regression) methods.Results In SAP patients,the morbility of ARF was 10.7%.The distinct impact factors of it were the patients’age,the duration of SIRS,severity grade(APACHE Ⅱscore,CT score),ARDS,MODS,ACS,infection and local complications and so on.18 of 54 patients with ARF were dead and the motality was 33.3%.Complicating ARDS and MODS simultaneously was the important reason of increasing motality,but whether complicating the infection around pancreas was not.Conclusion ARF is the severe complication of SAP,early liquid resuscitation,function protection of vital organs and positive eduction are the important measures to prevent SAP from complicating ARF and improve the prognosis.更多还原