Analysis Of The Occurrence And Risk Factors Of Gastrointestinal Fistula In Severe Acute Pancreatitis

Purpose:The purpose of the article is to investigate the occurrence of gastrointestinal fistula and the risk factors of gastrointestinal fistula in the development of severe acute pancreatitis,and for early clinical intervention to reduce the occurrence of gastrointestinal fistula in patients with severe acute pancreatitis.Methods:It is a retrospective analysis of the clinical data of 218 patients with severe acute pancreatitis who met the study criteria from January 1,2010 to January 1,2019,the First Affiliated Hospital of Nanchang University.The patients are divided into gastrointestinal fistula group and nongastrointestinal fistula group according to the presence or absence of gastrointestinal fistula.Gastrointestinal fistula group and nongastrointestinal fistula group were used to analyze the clinical features of gastrointestinal fistula,whatmore,combined with prognosis related factors of acute pancreatitis,we collected the relevant data which are mainly from whether or not iatrogenic operation,enteral nutrition,organ failure,infection related indicators.single factor analysis was performed on related indicators,and statistically significant factors were selected.Finally,we use multivariate logistic regression to obtain independent risk factors for gastrointestinal fistula in SAP patients.Results:1.Among the 218 patients with severe acute pancreatitis,there are 182 patients without gastrointestinal fistula,38 of whom died,the mortality rate is 20.9%,the median hospital stay is 17 days,and the median hospitalization cost is ?71889.7;there are 36 cases of gastrointestinal fistula group,including 12 death patients,the mortality rate is 33.3%,the median hospital stay is 59 days,the median hospitalization cost is ?181539.5;The mortality rate is no statistically significant difference between nongastrointestinal fistula group and gastrointestinal fistula group(P>0.05),but there is a statistical difference in hospitalization time and hospitalization expenses between the two groups(P<0.05).Comparison of the prognostic factors between the death group and the non-death group of patients with gastrointestinal fistula,we find albumin and serum calcium were statistically different between the groups(P<0.05).2.In the statistical analysis of risk factors,early enteral nutrition,APACHE II score,modified CT severity index score,iatrogenic operation,pancreatic necrosis and infection are statistically significant(P<0.05).In multivariate logistic regression analysis,iatrogenic operations(P=0.01,OR=3.185),improved CT severity index scores(P=0.026,OR = 1.251),and pancreatic necrosis(P= 0.002,OR = 4.83)are independent risk factor for gastrointestinal fistula,early enteral nutrition(48-72 hours onset)(P=0.033,OR=0.402)is a protective factor for the prevention of GIF,and blood type is not associated with GIF in patients with severe acute pancreatitis.(P>0.05).Conclusion:There is no difference in mortality between patients with intestinal fistula and those without gastrointestinal fistula,but the average cost and hospitalization time during hospitalization are significantly higher than those without gastrointestinal fistula.Clinically,we still need to pay attention to the patients with gastrointestinal fistula.Albumin and serum calcium can be used as a reference for assessing the prognosis of patients with gastrointestinal fistula.Iatrogenic operation,improved CT severity index score,pancreatic necrosis and infection are independent risk factors for gastrointestinal fistula in patients with severe acute pancreatitis.Early enteral nutrition is a protective factor for preventing gastrointestinal fistula.The occurrence of gastrointestinal fistula is not related to the blood type of patients.