改良的早期预警评分在急性胰腺炎中的应用

目的 探讨改良的早期预警评分(MEWS)在急性胰腺炎轻重和病程评估方面的作用.方法 上海交通大学医学院附属仁济医院2006年11月至2007年5月由急诊收入92例急性胰腺炎的患者.急性胰腺炎的诊断采用美国急性胰腺炎临床指南的标准,符合以下三条中的二条:(1)具有急性胰腺炎特征性腹痛;(2)血清淀粉酶≥正常值上限3倍;(3)急性胰腺炎特征性的B超或CT表现.患者本身合并有心肺肝肾功能不全等疾病的排除在外.入院后第1,2,3天记录患者的MEWS评分,观察其分值分布及动态变化.根据MEWS评分分为重危组(MEWS≥4)和一般组(MEWS<4),比较两组患者的病程、器官衰竭发生率和死亡率.对患者入院当天分别行MEWS评分、Rason评分和急性生理与慢性健康评分(APACHEⅡ评分),观察其相关性.统计方法采用相关性分析以及团体t检验.率的比较采用X~2检验.结果 MEWS分值≥4分的患者病程明显长于其他患者,器官衰竭发生率明显增高,且经过处理后分值未能下降的患者死亡率更高.MEWS评分与Rason评分、APACHEⅡ评分呈正相关.结论 MEWS评分可以用来评估急性胰腺炎患者的轻重及预后.MEWS评分简便易行,适合早期筛选危重急性胰腺炎患者.

Study on the application of modified early warning score system in patients with acute pancreatitis

Objective To evaluate the modified early warning score (MEWS) system in the assessment of the severity and prognosis in acute pancreatitis (AP). Method Ninety two AP patients had been recruited from the Department of Emergency Medicine during November, 2007 to May, 2008. All patients fulfilled at least 2 of the three criteria of American AP clinical guideline, (1) typical abdominal pain; (2) serum amylase level ≥3times of upper normal limit; (3) typical ultrasound or CT findings for AP. Patients with cardiac, pulmonary, hepatic , renal insufficiency or other comorbidities were ruled out. Each patient was evaluated MEWS at day 1,2, and 3 after admission, and subsequently stratified into two groups: high risk group with MEWS ≥4 and moderate risk group with MEWS < 4. The clinical course, end organ failure, and mortality rate was compared between two groups. Other parameters including Ranson score, APACHE Ⅱ score were also obtained. Spearman correlation,group student t test, or Chi square tests were used. Results High risk group has significant prolonged clinical course ( P < 0.05 ) , higher end organ failure rate (P < 0.01) , compared to low risk group. Patients who can not achieve MEWS improvements after interventions have the highest mortality rate (P < 0.01). The MEWS positively correlated with Ranson and APACHE Ⅱ scores ( r = 0.486, and 0.583, respectively, P <0.05). Conclusions MEWS is a valid and simple tool to evaluate severity and prognosis of AP in early stage.