| Objective:Acute pancreatitis is a common acute abdomen in clinical practice.It has complicated etiology,dangerous complications and highly mortality rate.Although the research on the pathogenesis of acute pancreatitis has gradually deepened and the treatment of acute pancreatitis has progressed,the mortality rate is still as high as 30%.Early death is the most common especially.Therefore,it is especially important to find early warning indicators for the severity of acute pancreatitis and to accurately predict the prognosis of patients.It is important to reduce complications,reduce mortality and shorten length of stays.This study retrospectively analyzed the basic conditions,laboratory data,complications and prognosis of 761 patients with acute pancreatitis,and explored the etiology of acute pancreatitis,clinical features of severe acute pancreatitis and prognosis-related factors.Provides a reference for early identification,timely intervention,and prognostic evaluation of severe pancreatitis.Method:General information,laboratory data,complications and prognosis of 761 patients with acute pancreatitis who were hospitalized in the Department of Hepatobiliary and Pancreatic Surgery from January 1,2012 to December 31,2017 were collected.The data were analyzed by SPSS 23.0,and drawing the chart with EXCLE.Results:1.General information on acute pancreatitis:761 patients with acute pancreat itis,Median age was 43(34,53).Male to female ratio was 1.69:1.The main caus es include:biliary(33.0%),hyperlipidemia(25.5%),alcohol(23.0%),overeating(12.0%),unknown and other cases(6.5%).There were significant differences in the di stribution of gender and age with acute pancreatitis of different causes(P<0.05).2.Clinical characteristics of acute biliary pancreatitis and hyperlipidemic acutepancreatitis:The proportion of biliary and hyperlipidemia in acute pancreatitis had a temporal trend.The composition ratio of acute biliary pancreatitis showed a fluctuating downward trend,and the composition ratio of hyperlipidemic acute pancreatitis showed a fluctuating upward trend.251 cases of acute biliary pancreatitis,male to female ratio was 0.92:1.The average age was 49.00±16.02.194 cases of hyperlipidemic acute pancreatitis,male to female ratio was 1.37:1.The average age was 41.19±12.34.The age of patients with hyperlipidemic acute pancreatitis(41.19±12.34)was significantly lower than that of acute biliary pancreatitis(49.00±16.02)(P<0.05).The proportion of males,diabetes,fatty liver,smoking and alcohol consumption in hyperlipidemia acute pancreatitis was higher than that in acute biliary pancreatitis group,and the difference was statistically significant(P<0.05).The length of stays in the hyperlipidemic acute pancreatitis group was significantly longer than that in the acute biliary pancreatitis group(P<0.05).White blood cells,neutrophils,neutrophil to lymphocyte ratio,hematocrit,cholinesterase,uric acid,serum creatinine positive rate,cholesterol,triglyceride,fasting blood glucose level of hyperlipidemia acute pancreatitis were significantly higher than acute biliary pancreatitis group(P<0.05).The mean red blood cell volume,aspartate transaminase positive rate,alanine transaminase positive rate,γ-glutamate transpeptidase positive rate,alkaline phosphatase positive rate,albumin,total bilirubin,direct bilirubin,total bile acid,high-density lipoprotein cholesterol,alpha-fetoprotein,and serum calcium levels of hyperlipidemia acute pancreatitis were significantly decreased than acute biliary pancreatitis group(P<0.05).The proportion of severe acute pancreatitis in hyperlipidemic acute pancreatitis was significantly higher than that of acute biliary pancreatitis(P<0.05),suggesting that the risk of severe acute pancreatitis in hyperlipidemic acute pancreatitis was higher than that of biliary group,and with a hazard ratio of 3.2(95% CI: 1.93-5.32).3.Analysis of clinical features of severe acute pancreatitis and non-severe acute pancreatitis:649 patients with non-severe acute pancreatitis,male to female ratio was 1.73:1.Median age was 42(34,52).112 SAP patients,male to female ratio was 1.49:1.Median age was 45(35,58).The proportion of patients with severe acute pancreatitis complicated with fatty liver(67.0%)was higher than that of non-severe acute pancreatitis group(48.1%),and the difference was statistically significant(P<0.05).The length of stays and fatty liver ratio of severe acute pancreatitis patients was significantly higher than those of non-severe acute pancreatitis(P<0.05).White blood cells,neutrophils,monocytes,ratio of neutrophils to lymphocytes,width of red blood cells,mean platelet volume,width of platelet distribution,ratio of platelets to lymphocytes,distribution of red blood cells and platelet ratio,aspartate transaminase,blood urea nitrogen,serum creatinine,triglyceride,fasting blood glucose,prothrombin time level of severe acute pancreatitis were significantly higher than non-severe acute pancreatitis(P<0.05).Lymphocyte,lymphocyte to monocyte ratio,platelet,cholinesterase,albumin,white ball ratio,prognosis nutritional index,cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,serum calcium level of severe acute pancreatitis were significantly lower than non-severe acute pancreatitis(P<0.05)4.Analysis of prognostic factors in severe acute pancreatitis :Among 112 patients with severe acute pancreatitis,71.5% patients were discharged and improved from hospital,other 28.5% were death group.The age of patients in the death group(51.91±14.76)was significantly greater than that in the discharged and improved group(44.94±14.57)(P<0.05).The proportion of gallstones in the death group(37.5%)was significantly higher than that in the discharged and improved group(16.3%)(P<0.05).The length of stays of death group was significantly lower than that in the discharged and improved group(P<0.05).The mean erythrocyte hemoglobin concentration,cholinesterase,albumin,cholesterol,low-density lipoprotein cholesterol,and prognostic nutrition index in the death group were significantly lower than discharged and improved group(P<0.05).The aspartate transaminase in the death group was significantly higher than that in the discharged and improved group(P<0.05).Of the 112 patients with severe acute pancreatitis,major organ and systemicfailures included respiratory failure(52.7%),liver failure(31.3%),renal failure(27.7%),cardiovascular failure(19.6%),and coagulation functional failure(6.3%).Respiratory failure in the death group(68.8%),cardiovascular failure(43.8%),liver failure(46.9%),multiple organ failure(62.5%),pleural effusion(78.1%),the proportion of peritoneal effusion(87.5%)was significantly higher than that of the discharged and improved group(P<0.05).19 cases of microbial pathogens(gram-negative bacilli,Gram-positive cocci,fungi)in the severe acute pancreatitis group.The proportion of infections in the death group(34.3%),the proportion of lung infections(28.1%),the proportion of Gram-negative bacilli infections(28.1%),and the proportion of fungal infections(18.8%)were significantly higher than those in the improved discharge group(P<0.05).By binary logistic regression analysis,cardiovascular system failure(OR=11.57,95%CI:1.36-98.59,P=0.025),gallstones(OR=5.34,95%CI:1.13-25.23;P=0.035)were independent factors for death from severe acute pancreatitis.Conclusions:1.In 761 cases of acute pancreatitis,hyperlipidemia acute pancreatitis and acute biliary pancreatitis were the two most common types.The proportion of hyperlipidemic acute pancreatitis was increasing year by year.2.Hyperlipidemia acute pancreatitis was more serious than acute biliary acute pancreatitis,the risk ratio was 3.2(95% CI: 1.93-5.32).3.Cardiovascular system failure,gallstones were independent factors related to the death of severe acute pancreatitis. |
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