MỘT SỐ YẾU TỐ TIÊN LƯỢNG Ở BỆNH NHÂN VIÊM TỤY CẤP TÍNH NẶNG CÓ PHẪU THUẬT

Abstract

Purpose: Evaluation of prognostic factors in patients with severe acute pancreatitis undergoing surgery.  Method and study design: A cross-sectional descriptive study of 43 patients with severe acute pancreatitis who had surgery, were treated at the Intensive Care Unit of Bach Mai Hospital, the Emergency and Intensive Care Department of Hanoi Medical University Hospital from September 2019 to August 2021. Results: The mean age of the study group was 52±16.32 (age), the ratio male:female was 3:1. The most common age group for men is from 45 to 60 years old, accounting for 37.2%. The survival rate in the group was 79.05%. The patient's history includes 46.51% alcoholism, 37.20% patients with a history of acute pancreatitis, 4 cases with previous gallstones and 3 patients with acute pancreatitis during pregnancy. The reasons indicated for surgery in the study group, with the highest rate being pancreatic necrosis accounted for 48.83%, followed by pancreatic abscess accounted for 32.55%, there were 3 patients with acute obstructive pancreatitis with stones. biliary tract, 1 case of peritonitis and 3 cases of intra-abdominal bleeding complications indicated emergency surgery. Intra-abdominal pressure was assessed to be significant in the prognosis of mortality, with the average group of survivors having an average intra-abdominal pressure of 20.2 ± 4.8% and the group of death 24.1 ± 6.0 higher. Using the scale at admission and during treatment to assess the prognosis of the patient's condition, the 2 scores SOFA, APACHE II, Marshall and  RASON differed between the 2 groups with p<0.05. The PCT at hospital admission also had a difference with the mean of survival group was 12.6±19.4 compared with the mortality group was 21.18±17.7. Conclusion: The prognostic factors in patients with severe acute pancreatitis undergoing surgery are the clinical status of increased intra-abdominal pressure, PCT, and severity scores such as SOFA, APACHE II, Marshall and  RASON.