早期乳酸/白蛋白值对评估重症急性胰腺炎气管插管率的价值-东南大学学报医学版

早期乳酸/白蛋白值对评估重症急性胰腺炎气管插管率的价值

单位：南通大学附属医院重症医学科, 江苏南通 226000

分类号：R576

出版年·卷·期（页码）：2022·41·第一期（138-143）

摘要：

目的：探讨早期乳酸/白蛋白（Lac/Alb）值对评估重症急性胰腺炎患者气管插管率的价值。方法：采用回顾性队列研究方法，选择2015年1月至2020年12月南通大学附属医院重症医学科收治的诊断符合重症急性胰腺炎的患者136例，分为插管组和未插管组，比较两组的临床基本信息和实验室检查结果；采用单因素和多因素Logistic回归分析重症急性胰腺炎患者气管插管的危险因素；对存在差异的绘制其受试者工作特征（ROC）曲线，比较差异组的截断值和灵敏度。结果：纳入研究共136例重症急性胰腺炎患者，接受气管插管的患者为47例，气管插管率为34.56%，插管组患者入ICU时急性生理与慢性健康评估（APACHE）Ⅱ评分、序贯器官衰竭评估（SOFA）评分及年龄均高于未插管组（均P<0.05）。但两组之间性别和基础疾病（高血脂、饮酒史、胆石症、高血压、糖尿病和慢性阻塞性肺疾病）差异无统计学意义。实验室检查单因素结果比较，插管组患者基线尿素氮、Lac、Lac/Alb值、血淀粉酶和腹内压均高于未插管组，Alb低于未插管组，其他实验室检查白细胞计数、血红蛋白、血小板计数、血肌酐、总胆红素、血糖、血钙两组比较差异无统计学意义。接受气管插管患者的多因素Logistic回归分析显示，APACHE Ⅱ评分、SOFA评分、Lac/Alb值和腹内压情况是重症急性胰腺炎患者接受气管插管的独立危险因素。ROC曲线分析显示，APACHE Ⅱ评分、SOFA评分和Lac/Alb值都可以作为预测患者接受气管插管因素，Lac/Alb敏感度更高、效果更好。结论：入院时患者Lac/Alb值可以作为预测重症急性胰腺炎是否接受气管插管的指标，对于早期治疗有一定的意义。

Objective: To investigate the value of early lactate/albumin(Lac/Alb) ratio in evaluating the tracheal intubation rate for patients with severe acute pancreatitis. Methods: A retrospective study was performed on 136 patients with serve acute pancreatitis who admitted in the Intensive Care Unit of Affiliated Hospital of Nantong University from January 2015 to December 2020.All patients were divided into intubation group and non-intubation group,and the basic clinical and laboratory data of the two groups were compared;Univariate and multivariate Logistic regression were used to analyze the risk factors of tracheal intubation in patients with severe acute pancreatitis; The receiver operating characteristic(ROC) curves were plotted for those with differences, and the cutoff values and sensitivities of the difference groups were compared. Results: A total of 136 patients were included in the study. 47 patients received intubation, and the intubation rate was 34.56%. The acute physiology and chronic health evaluation(APACHE)Ⅱ score, sequential organ failure assessment(SOFA) score and age of patients in the intubation group were higher than those in the non-intubation group in the ICU(P<0.05). They had no differences in gender and primary diseases(hyperlipidemia, drinking history, cholelithiasis, hypertension, diabetes and chronic obstructive pulmonary disease) between the two groups. The baseline urea nitrogen, Lac, Lac/Alb, blood amylase and intra-abdominal pressure in the intubation group were higher than those in the non-intubation group, and Alb was lower than that in the non-intubation group. Other laboratory tests showed no differences in white blood cell count, hemoglobin, platelet count, serum creatinine, total bilirubin, blood glucose and blood calcium between the two groups. Multiple Logistic regression analysis showed that APACHE Ⅱ score, SOFA score, Lac/Alb and intra-abdominal pressure were independent risk factors for tracheal intubation in severe acute pancreatitis patients. ROC curves analysis showed that APACHE Ⅱ score, SOFA score and Lac/Alb could be used as predictors of tracheal intubation, and Lac/Alb had higher sensitivity and specificity. Conclusion: Lac/Alb ratio is of high value in predicting intubation of severe acute pancreatitis for early treatment.

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