重症急性胰腺炎病人重症监护室获得性衰弱的影响因素分析

向登琼; 周茹; 王惠

文章摘要

向登琼,周茹,王惠.重症急性胰腺炎病人重症监护室获得性衰弱的影响因素分析[J].安徽医药,2021,25(6):1194-1198.

重症急性胰腺炎病人重症监护室获得性衰弱的影响因素分析

Analysis of the influencing factors of ICU acquired weakness in patients with severe acute pancreatitis

DOI：10.3969/j.issn.1009-6469.2021.06.033

中文关键词: 重症急性胰腺炎 ICU获得性衰弱早期活动障碍

英文关键词: Acute severe pancreatitis Acquired weakness in intensive care unit Early activity disorder

基金项目:

作者	单位
向登琼	攀枝花市中西医结合医院重症医学科，四川攀枝花 617000
周茹	攀枝花市中西医结合医院重症医学科，四川攀枝花 617000
王惠	攀枝花市中西医结合医院重症医学科，四川攀枝花 617000

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中文摘要:

目的分析重症急性胰腺炎( SAP)病人重症监护室( ICU)获得性衰弱( ICU-AW)的危险因素。方法选取 2015年 1月至 2019年 1月入住攀枝花市中西医结合医院 ICU的 SAP病人 128例作为研究对象，评估 ICU-AW及活动障碍情况，对病人的一般资料、病情、治疗措施等资料进行记录，采用单因素分析 ICU-AW相关因素，采用多因素 logistic分析 SAP病人 ICU-AW的独立危险因素。结果入住 ICU的 SAP病人 ICU-AW发生率为 44.53%(57/128)衰弱部位以肩关节、髋关节、膝关节为主。单因素分析显示，发生 ICU-AW病人年龄 >65岁、体质量指数 <23 kg/m2、Marshall评分(，呼吸、肾脏、循环) ≥3分、急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)评分 ≥4分、 BISAP评分 ≥4分、代谢功能障碍、病程为中后期、原发病为胆源性急性胰腺炎、有腹腔感染、手术治疗、肠外营养、活动障碍持续时间 ≥187 h、气管插管、手术制动及有循环障碍所占比例( 66.67%、45.61%、73.68%、 73.68%、40.35%、71.93%、63.16%、64.91%、63.16%、61.4%、24.56%、64.91%、40.35%、66.67%、57.89%、56.14%、42.11%)均明显高于未发生 ICU-AW病人( 47.89%、26.76%、56.34%、39.44%、21.13%、49.3%、38.03%、46.48%、35.21%、33.8%、11.27%、29.58%、 23.94%、42.25%、35.21%、36.62%、25.35%)；多因素 logistic回归分析显示，年龄 >65岁、循环系统 Marshall评分 ≥3分、胆源性急性重症胰腺、腹腔感染、手术治疗、肠外营养、早期活动障碍时间、气管插管及术后制动是 SAP病人并发 ICU-AW的独立危险因素。结论重症急性胰腺炎病人并发 ICU-AW概率较高，年龄、循环系统 Marshall评分、胆源性急性重症胰腺、腹腔感染、手术治疗、肠外营养、早期活动障碍时间、气管插管及术后制动均是其独立危险因素，应针对 ICU-AW的危险因素进行适当的干预，改善病人的预后。

英文摘要:

Objective To analyze the risk factors of ICU acquired weakness (ICU-AW) in patients with severe acute pancreatitis (SAP).Methods Totally 128 SAP patients who were admitted to ICU of Panzhihua Integrated Hospital of Traditional Chinese andWestern Medicine from January 2015 to January 2019 were selected as the research objects for the assessment of ICU-AW and dysactivity. General information, condition and treatment measures were recorded, and related factors of ICU-AW were analyzed by single factor analysis and the independent risk factors of ICU-AW were analyzed by multifactor Logistic analysis.Results Incidence of ICUAW in SAP patients who were admitted to ICU was 44.53%(57/128). The main weakening sites were shoulder joint, hip joint and kneejoint. Univariate analysis results showed that the proportions of patients with ICU-AW in the age>65 years old, with BMI<23 kg/m2,Marshall score (respiratory, renal, and circulatory systems)≥3 points, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score≥4 points, BISAP score≥4 points, metabolic dysfunction, middle and later course of disease, primary disease being acute gallstonepancreatitis, abdominal infection, operative treatment, parenteral nutrition, duration of dysactivity ≥187 h, tracheal intubation, surgicalimmobilization and circulatory disturbance (66.67%, 45.61%, 73.68%, 73.68%, 40.35%, 71.93%, 63.16%, 64.91%, 63.16%, 61.4%,24.56%, 64.91%, 40.35%, 66.67%, 57.89%, 56.14%, 42.11%) were significantly higher than those in patients without ICU-AW (47.89%, 26.76%, 56.34%, 39.44%, 21.13%, 49.3%, 38.03%, 46.48%, 35.21%, 33.8%, 11.27%, 29.58%, 23.94%, 42.25%, 35.21%,36.62%, 25.35%). Multivariate Logistic regression results showed that age > 65 years old, Marshall score of circulatory system ≥ 3points, biliary acute severe pancreas, abdominal infection, surgical treatment, parenteral nutrition, time of early dysactivity, tracheal intubation and post-operative braking were independent risk factors for SAP patients with a complication of ICU-AW.Conclusion Patients with severe acute pancreatitis are more likely to develop ICU-AW. Age, Marshall score of circulatory system, biliary acute severepancreas, abdominal infection, surgical treatment, parenteral nutrition, time of early dysactivity, tracheal intubation and post-operative braking are its independent risk factors. The risk factors of ICU-AW need to be targeted for appropriate intervention to improve the prognosis of patients.

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