Clinical Analysis Of 512 Cases With Severe Acute Pancreatitis In 10 Hospitals In North China

Acute pancreatitis is a common acute abdominal pain in clinical,Its clinical manifestation and its course of disease and prognosis are complex and changeable.Severe acute pancreatitis often occurs in a variety of serious complications,and lead to multiple organ failure,the mortality is high.Therefore,more and more people pay attention to the severe pancreatitis.It is necessary to carry out intensive epidemiological study on severe acute pancreatitis.Methods:This is a prospective,observational study.,Criteria for the diagnosis of severe acute pancreatitis in the United States by the classification of AP in the United States in 1992 and 2008.Selected from Shandong province,Beijingcity etc,10 3A-level hospitals were used as cooperative center.It conduct The data of 512patients with SAP,from these 10 hospitals in 2011-2016,The basic demographic data,past history,bad habits,main diagnosis,infection characteristics,clinical diagnosis and treatment,prognosis,medical burden and other data were collected.After data collection,unified registration into the computer Access system,the risk factors,morbidity,mortality,infection etc,analysis of severe acute pancreatitis by using SPSS20.0 software,Continuous variables are represented with x-± s.Count data using X2 test,t test measurement data line,and the normal distribution does not match the two samples were then used ranks um test;P<0.05 was considered statistically significant(two-sided test).AP diagnosis is based on clinical symptoms(sudden abdominal pain)laboratory examination(blood amylase or blood lipase above 3 times the upper limit of the normal value)、imaging examination(abdominal B ultrasound,CT,MRI)。Severe acute pancreatitis(SAP)judged according to the following criteria:(1)with organ failure(shock,respiratory failure,renal failure or gastrointestinal bleeding)or CT(check local complications of pancreatic necrosis,abscess,pseudocyst);(2)APACHEⅡ score ≥ 8;(3)Ranson score>3.Result:1.In the 512 patients,304(59.4%)were male and the average age was 55.5 ± 19.2 years,Mean APACHE Ⅱ score was 17±7.9,and the average RANSON score was 6.5 ±3.8;296 cases(57.8%)had basic diseases,including hypertension,coronary heart disease,diabetes mellitus,solid tumor and chronic obstructive pulmonary disease,fatty liver and hyperlipidemia.In the cases of gallstone(n=296)accounted for 57.8%,idiopathic(n=86)accounted for 16.8%,alcohol accounted for 9.8%(n=50),hyperlipidemia(n=56)accounted for 10.9%,pregnancy with acute pancreatitis(n= 12)accounted ’for 2.3%,Recurrent pancreatitis(n=10)accounted for 1.9%.The incidence of severe acute pancreatitis increased year by year,the proportion rose from 17.9%in 2011 to 22.8%in 2015.The most common complications of SAP were the lung(acute respiratory distress syndrome)(32%),kidney damage(28.5%),pleural effusion(25.8%),GI(gastrointestinal bleeding,intra-abdominal hypertension)(27.7%),heart failure(16.8%),pancreatic encephalopathy(2.3%).Severe pancreatitis shouldbe carried out abdominal CT examination to determine the CT classification.SAP complicated with infection(32.6%),common infection site:lung(17%),peripheral pancreas(16%),biliary tract(8.6%),abdominal cavity(4.5%).Urinary tract(3.1%).Gram negative bacilli were the most common bacterial infections,and gram positive bacilli were rare.2.logistic regression was used to screen the risk factors of severe acute pancreatitis.Multiple factors analysis showed that,compared with the mild acute pancreatitis,Obesity,man,with underlying diseases,biliary pancreatitis is easy to develop to severe acute pancreatitis.Obesity,age(50-59 years old),smoking history,lactate dehydrogenase(LDH),white blood cell(WBC),arterial oxygen partial pressure and urea nitrogen were the risk factors of severe acute pancreatitis.3.Procalcitonin combined with BISAP score and APACHE,II score,Ranson score,CTSI score and BISAP score compared to calculate the curve area,PCT combined with BISAP score for severe acute pancreatitis prediction value is higher。Conclusions:1.SAP age of onset is mainly concentrated in the elderly,male patients are slightly more than female patients;2.common causes:biliary origin,idiopathic,hyperlipidemia,alcohol,pregnancy with pancreatitis,recurrence,traumatic.3.Common infection sites:lung(17%),peripheral(16%)of the pancreas,biliary tract(8.6%),abdominal cavity(4.5%).Urinary tract(3.1%).Gram negative bacilli were the most common bacterial infections,and gram positive bacilli were rare,4.Common organ damage is the lung,kidney,gastrointestinal tract,heart function,pancreatic encephalopathy.5.acute severe acute pancreatitis at present to the internal medicine comprehensive treatment primarily,the specific treatment method and the choice of the medicine use is more.6.Mortality in elderly patients is higher than that in young patients;As the age increased,the mortality rate increased.;The mortality of severe idiopathic pancreatitis was the highest,;Biliary mortality was the lowest;The cause of the disease and the mortality of severe pancreatitis have a certain link.;Mortality is no gender difference.7.The incidence of severe acute pancreatitis was 20.1%in North China.。8.Obesity(BMI>25),Age(50-59 years old),smoking history,lactate dehydrogenase(LDH),white blood cell(WBC),arterial oxygen partial pressure and urea nitrogen were the risk factors of severe acute pancreatitis.。9.PCT combined with BISAP score has higher predictive value for severe acute pancreatitis.