Risk Factors For The Diagnosis And Treatment With Acute Pancreatitis

Background:Severe acute pancreatitis is a frequently-encountered clinical acute abdominal disease.SAP patients often have rapid onset and have symptoms of circulatory,respiratory and kidney function failure at early stage.In case of patients with poor prognosis,the mortality rate is high.SAP patients can have the symptoms of pancreatic necrosis,inflammatory mediator release.Patients at earlier stage often show symptoms of multiple organ failure which lead to death of the patients.At later stage,due to prolonged intestinal paralysis,increased intestinal permeability,a large number of intestinal bacteria and endotoxin shift to the pancreas,intestinal lymph nodes and blood,causing a massive release of inflammatory cytokines and then triggering the systemic inflammatory response syndrome(systemic inflammatory response syndrome,SIRS),a cascade of inflammation caused by multiple organ dysfunction syndrome(multiple organ dysfunction syndrome,MODS).The second fastigium of SPA mortality appear in this period.In the course current clinical diagnosis and treatment,emphasis should be placed on assessment of acute intestinal function,infectious pancreatic necrosis prediction,late complications such as pancreatic fluid collection and treatment of infected pancreatic necrosis.Objectiv:By retrospectively analyzing the related clinical diagnosis and treatment data of SPA patients received and treated in the ICU of Changhai Hospital,this paper will research(1)the application value of AGI grading system in the treatment of acute pancreatitis(2)risk factors associated with infectious pancreatic necrosis(3)risk factors associated with the failure of CT guided PCD in the treatment of infectious pancreatic necrosis(4)risk factors associated with the failure of pancreatic fluid volume poly.Methods: This paper will retrospectively analyze the following clinical information of patients with acute pancreatitis received and treated in the ICU of Changhai Hospital,including the general personal information of patients(gender,age,etiology,length of stay,etc.),patients admission score(MCTSI,Mshall score,AGI grading,etc.),checking(PCT),the relevant medical information(nutrition,fluid resuscitation,PCD drainage site,time,type of stent,complications,and etc.)and the outcome of patients.Statistically analyzed in SPSS statistical software(version 19.0),measurement data is expressed in mean±s,if it meet the normal distribution,it will next be checked under the unpaired t test,if not,checked under two independent samples comparison of Mann-Whitney U test;Count data will be examined by the Fisher’s exact test.Multivariate analysis is performed using multivariate unconditional Logistic regression analysis model.Results:(1)AGI grading is closely related to the severity of patients with acute pancreatitis;Compared with the commonly used clinical score,AGI grading is more associated with death and infection of pancreatic necrosis.(2)The risk factors of infectious pancreatic necrosis are the results of MCTSI and target oriented fluid infusion.(3)The risk factors of the multiple drug resistant bacteria infection in MCTSI and drainage fluid are the results of the failure of pancreatic necrosis tissue infection after percutaneous puncture and catheter drainage under CT guidance.(4)The risk factors of the failure of pancreatic duct stent implantation and liquid accumulation CT are the result of the failure of the pancreatic fluid volume accumulation in simple ERCP.Conclusion: AGI grading was correlated with the severity of acute pancreatitis;MCTSI and goal directed fluid infusion are the risk factors for infectious pancreatic necrosis;Selective treatment for infectious pancreatic necrosis and pancreatic fluid volume poly therapy should be performed according to different assessments.