Clinical Analysis Of Severe Acute Pancreatitis Combined With Acute Lung Injury

Objective To investigate the clinical characteristics of severe acute pancreatitis (SAP) and that are combined with acute lung injury (ALI/ARDS), analyze the possible risk factors, in order to make early diagnosis and provide treatments.Methods Retrospectively collected SAP patients admitted to our hospital during the year 2000 to 2007, selected those combined with ALI/ARDS, and carry out statistical analysis on following aspects: cause, incidence, case fatality, age, gender, basic disease, occurance of SIRS, Ranson score, APACHE II score, organ involvement, course of ALI/ARDS, oxygenation, respiratory support, infection, treatment, and so on. P<0.05 was defined as of statistical significance.Results 1183 AP patients were admitted during the year 2000 and 2007, in which 188 were SAP, and 26 of which gave up therapy; 70 patients were combined with ALI/ARDS, 19 died, case fatality was 27.1%. Biliary, dietary and alcoholic pancreatitis took up 32.5%, 28.7% and 17.0% of SAP cases. The incidence of SAP patients combined with dysfunction of lung, liver, cardiovascular, kidney, brain or coagulation was 43.21%, 29.62%, 22.84%, 20.37%, 9.88% and 6.17%; their case fatality was 27.14%, 18.75%, 45.95%, 39.39%, 52.63%, 37.50% and 80.0%. There was no significant difference among the yearly incidence of SAP and those combined with ALI/ARDS, so was the case fatality (P>0.05). The case fatalities of SAP patients and those combined with ALI/ARDS at different age were of remarkable statistical significance (P<0.01), people>55 years old had higher case fatality. The case fatalities were much higher in patients whose basic diseases or number of involved organs≥3 (P<0.05). The proportion of ALI/ARDS patients developed SIRS was 80.00%, the case fatality of patients corresponding to 4 SIRS indexes was 58.33% (P<0.05). The case fatality was 27.27%, 23.81%, 57.14%, 75.00% and 100.0% in SAP patients whose Ranson score was 3, 4, 5, 6 and 7 (P<0.05). Case fatality of patients whose APACHE II score≥8 and <8 was separately 39.29% and 19.05%(P=0.0621). The fatality of patients whose CT grade was E was higher than others (34.00%, P<0.05).There were 60% and 87.14% ALI/ARDS develpoed within 72h and 7d after SAP onset, the case fatalities were of no statistical difference as compared with original oxygenation (OI, PaO₂, and FiO₂) , the fatality of whose ALI/ARDS course>21d was 77.78%, and patients with fundamental diseases or imaging lung alteration in lung had higher fatalities(P<0.05). The case fatality of patients with different respiratory support, such as without oxegen therapy, with oxygen therapy through nasal ductus or face mask, and with noninvasive mechanical ventilation (NIMV) or invasive mechanical ventilation (IMV) was 50.00%, 15.39%, 13.04%, 0 and 64.71% (P<0.05). Most of the infection happened 7d after the onset of SAP, and mainly in lung, abdominal cavity and digestive canal, the case fatality of patients with infection sites≥2 was higher than others (P=0.0111). 37 cases of ALI/ARDS patients developed sepsis, their duration of ALI/ARDS, mean hospitalization time and the number of involved organs were higher than those without sepsis (P<0.05).For patients who underwent blood purification, their APACHE II score and Ranson score were higher, while the ultimate numbers of involved organs and hospitalization time were lower than those who did not have blood purification (P>0.05). There was no significant difference in case fatalities between patients underwent surgery or not (15.15% vs 11.63%, P=0.8006). The 14 patients who had been admitted to ICU had worse conditions as compared in case fatality, hospitalization time, APACHE II score, Ranson score, number of involved organs, OI and incidence of sepsis (P<0.05), while the case fatality of sepsis patients in ICU was lower(P>0.05). Bayes discrimination indicated that age, CRP, Ranson score, OI and serum glucose altogether could provide 89.19% correct judgement on prognosis.Conclusion ALI/ARDS is a common complication of SAP, risk ractors associated with case fatality were as follows: age>55, corresponding to 4 SIRS indexes, Ranson score≥3, having pulmonary alterations, basic diseases≥3, number of involved organs≥3, infected sites≥2, having sepsis, requiring MV or blood purification treatment (P<0.05). Prompt and proper combined treatment like MV, blood purification and surgery were beneficial in ameliorating the condition of severe cases.