Một số yếu tố tiên lượng tử vong ở bệnh nhân viêm tụy cấp nặng

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Tác giả: Xuân Cơ Đào, Yên Ca Hồ

Ngôn ngữ: vie

Ký hiệu phân loại: 616.37 *Diseases of pancreas

Thông tin xuất bản: Y học Việt Nam, 2017

Mô tả vật lý: 124-129

Bộ sưu tập: Metadata

ID: 536062

Thêm vào giỏ

Mô tả hồ sơ bệnh án của 109 tường hợp viêm tụy cấp nặng điều trị tại khoa Hồi sức tích cực, bệnh viện Bạch Mai trong năm 2016. Kết quả cho thấy số bệnh nhân tử vong là 17, chiếm 15,6%. Nguyên nhân gây bệnh chủ yếu là do rượu và tăng triglyceride. Trong 3 ngày đầu, điểm SOFA và số tạng suy là yếu tố tiên lượng tốt nhất về tử vong. Xét nghiêm procalcitonin, ure, và creatinine là các xét nghiệm có giá trị tiên lượng trong 3 ngày đầu.Objects: Identify the mortality rate and mortality prognose factors in severe acute pancreatitis patients. Methods: A restrospeetive study was applied. The authors reviewed 109 medical records of severe acute pancreatitis patients in Department of Intensive Care, Bach Mai Hospital in 2016. Results: 109 severe acute pancreatitis patients were included in the analysis, average age was 48,80 ± 13,31, the youngest was years old and the oldest was 87 years old. Among those, the rate of males was much higher than ones of female (80.73% and 19.27%, respectively). The number of deaths were 17 persons, accounted for 15.6%. The average age of death and alive groups were 50.18 ± 13.26 and 48.54 ± 13.38, respectively (with p = 0,332). The ratio of male/female of the two group above were 4.7/1 and 4.1/1, correspondingly (with p = 1). The main causes of pancreatitis in both death and alive groups were accordingly alcohol abuse (41.8 % and 33.7%), hypertriglyceridemia (5.88% and 13.4%), and combination of both factors above (11.76% and 22.83%), there were no significant differences between two groups. In the first three days, SOFA score and number of organ failure were the highest score prognostic factors (with AUC in the first three days were 0.784
0.864
0.879 and 0.713
0.839
0.876, respectively), higher compared with BISAP score (AUC = 0.660) and APACHE II (AUC = 0.692) at admission. Procalcitonin, ure, and creatinine were subsclinical tests having prognotic value with flunetated AUC range accordingly 0.764 - 0.851
0.777 -0.841 and 0.767 - 0.835, there were no significant differences among ttiese tests. The cut-off points which were significantly associated with mortality prognostic ability in severe acute pancreatitis were SOFA score >
6 points, abdominal pressure >
21, ure >
7,8 (mmol/L), creatinine >
94(umol/L), procalcitonin >
3,21(ng/ml). Conclusion: Age, sex, and causes of disease were not a prognostoc factors for mortality in severe acute pancreatitis. In the first three days, SOFA score, number of failure organs, procalcitonin, ure and creatinine were good factors to prognosticate the possibility of death.

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