重症急性胰腺炎APACHEⅡ评分的应用价值

目的探讨APACHEⅡ评分在预测重症急性胰腺炎(SAP)严重度和预后中的作用.方法采用APACHEⅡ评分系统对52例SAP患者进行评分分析. 结果 SAP患者APACHEⅡ评分均值为(16.60±9.07)(8～40)分.其中分值为SAPⅡ级高于SAPⅠ级、死亡组高于存活组(均Ρ< 0.01).随着分值的增高,SAP的预测死亡风险率和实际病死率呈逐渐上升趋势(Ρ<0.01);且后两者之间呈正相关关系 (r=0.91, Ρ<0.01).结论 APACHEⅡ评分系统对评估SAP病情危重程度及预后具有参考价值.     

急性胰腺炎严重程度评分系统的临床研究进展

急性胰腺炎（acute pancreatitis,AP）是临床最常见的急腹症之一,近年来经过国内外学者共同努力,急性胰腺炎病死率和并发症发生率明显下降,但重症急性胰腺炎（severe acute pancreatitis,SAP）的病死率仍居高不下,临床早期识别SAP对改善患者预后至关重要。自提出AP严重程度评分后,临床判断病情严重程度便有了依据。随着疾病研究的进展,对临床初步判断AP病情严重程度的评分系统日益繁多,本文对目前临床使用较广泛的几种AP严重程度经典评估系统及近年来的研究进展做简单综述。     

重症急性胰腺炎的治疗与预后临床分析

目的探讨重症急性胰腺炎（severe acute pancreatitis，SAP）的治疗方法与预后的关系。方法回顾性分析收治的164例SAP的临床特征、治疗方法、并发症、病死率等资料。结果非手术治疗54例；手术治疗110例，其中早期手术69例，延期手术41例。早期手术的并发症发生率和病死率分别为81．2％和30．4％，明显高于非手术及延期手术治疗患者。结论SAP治疗方法是影响疗效的重要因素，早期采用非手术为主的综合治疗能有效降低并发症发生率和病死率，但对有早期手术或延期手术指征的患者，应及时手术治疗。     

重症急性胰腺炎的治疗与预后临床分析

目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)的治疗方法与预后的关系。方法回顾性分析收治的164例SAP的临床特征、治疗方法、并发症、病死率等资料。结果非手术治疗54例;手术治疗110例,其中早期手术69例,延期手术41例。早期手术的并发症发生率和病死率分别为81.2%和30.4%,明显高于非手术及延期手术治疗患者。结论SAP治疗方法是影响疗效的重要因素,早期采用非手术为主的综合治疗能有效降低并发症发生率和病死率,但对有早期手术或延期手术指征的患者,应及时手术治疗。     

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目的　探讨早期如何运用血液滤过改善重症急性胰腺炎 (SAP)的预后。方法　 1997年 4月至 2 0 0 2年7月采用血液滤过治疗SAP49例。其中普通型SAP(CSAP组 ) 3 4例 ,暴发性SAP(FSAP组 ) 15例 ,分析血滤参数和观察病人的手术率、非手术治愈率、总体存活率、住院时间和费用。结果　SAP和FSAP的血滤时间分别为 (5 45± 3 3 8)h与 (2 3 7± 2 2 1 6)h ,血液净化量、超滤液量和血滤器数目分别为 (75 0± 18 7)L与 (3 0 8 0± 3 61 6)L ;(2 2 45 5± 1186 1)mL与 (4 83 4 1± 2 83 2 8)mL ;(2 6± 1 3 )与 (2 9± 1 5 )个。CSAP组和FSAP组的中转手术率、非手术治愈率、总体存活率、住院时间、住院费用分别为 2 0 6% (7/ 3 4)与 73 3 % (11/ 15 ) ;10 0 % (2 7/ 2 7)与 2 5 % (1/ 4) ;91 2 % (3 1/ 3 4)与 60 % (9/ 15 ) ;(3 2 3± 10 4)天与 (13 5± 5 6 9)天 ;(5 3 4± 3 0 1)万元与 (2 9 3± 11 9)万元。结论　发病 72h内 ,重症胰腺炎加用短时血液滤过和暴发性胰腺炎急诊手术引流腹腔、后腹膜加持续血液滤过是进一步改善预后的良好措施     

营养治疗对重症急性胰腺炎预后的影响

目的 系统评价肠内营养、肠外营养对重症急性胰腺炎预后的影响.方法 采用Cochrane系统评价方法,由两名统计人员用计算机检索Cochrane图书馆、PubMed数据库、同时检索中国知网、中国生物医学文献数据库.收集国内外符合纳入标准的临床随机对照试验,按照纳入与排除标准选择文献,应用Revman 5.0软件进行Met...     

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重症急性胰腺炎治疗过程中面临的一个主要难题是在疾病的变化过程中预测其严重程度和潜在并发症。常见的评分标准包括Ranson、APACHEⅡ和序贯器官衰竭评分(SOFA)等。单一的预测指标除白细胞、血氧分压、血糖、血钙外,更有价值的有降钙素原、腹腔内压、BalthazarCT评分等。重症急性胰腺炎两个最重要标志是器官衰竭和胰腺坏死,预后评价应同时考虑器官衰竭和胰腺坏死因素,将形态学和生理学指标相结合,以提高预测的准确性。     

全身炎症反应综合征对重症急性胰腺炎预后的影响

目的: 了解重症急性胰腺炎（SAP）时全身炎症反应综合征（SIRS）的发生及其对预后的影响 。方法: 对37例SAP患者进行回顾分析,按治疗结果分为治愈组和死亡组,分别对SIRS标准、脏器受损情况及预后进行观察 。结果: 28例治愈（治愈组）,9例死亡（死亡组）。治愈组符合SIRS标准者23例（23/28）,其中符合3项以上者6例（6/28）,死亡组全部病例均符合SIRS诊断标准,其中符合3项以上标准者7例（7/9）。两组间统计,P<0.005。多器官功能障碍发生情况：治愈组4例（4/28）,死亡组9例（9/9）,P<0.005。SAP时SIRS的发生率较高,本组为84.21%（32/37） 。结论: 多器官功能障碍综合征（MODS）的发生随达到SIRS标准项目数的增加而大大增加,病死率也随之增高。     

On prognosis and treatment of acute severe pancreatitis with severe uremia

The prognosis of patients with acute pancreatitis and severe uremia is very poor. The mortality is nearly 80 per cent. In uremia requiring dialysis the mortality is 90 per cent in published materials. The slightly uremic patients, when dialysed, had a better prognosis than the severely uremic patients. The mortality in our material, consisting of cases usually dialysed at a late stage, was 100 per cent. Dialysis in these cases seems rather useless, considering the patients' severe cell damage caused by the toxic products emanating from the necrotic pancreas. It seems desirable to remove or depress the toxic focus surgically or by local irradiation as soon as possible. Attempts at a late stage to eliminate the toxic products from the pancreas and the abdominal cavity by peritoneal lavage or local radiation seem to have no effect.     

CT: early diagnosis and prognosis prediction of severe pancreatitis

Eighty-three onsets of severe pancreatitis were divided into grades A, B, and C according to CT findings, and, at the same time, into stages I, II, and III on the basis of 11 clinical criteria. The two classification systems were compared with each other with respect to patients clinical course, intraoperative observation, and the pathology of the pancreas. It was found that CT scanning is more valuable than clinical criteria in early diagnosis and outcome prediction in addition to advantages such as clear image, accurate location and direct surgical approach.     

Multiple factor scoring system for risk assessment of acute pancreatitis.

BACKGROUND: The initial prognostic classification of a pathologic event has important implications for management, outcome, and resource utilization. A variety of prognostic classification methods have been developed, but none has thus far shown consistent predictive accuracy in individual patients. In an attempt to overcome some of the limitations encountered by earlier workers, we have developed a simplified system for evaluation and prognosis of acute pancreatitis. MATERIALS AND METHODS: We studied retrospectively 306 patients with acute pancreatitis. Nonstandard statistical calculations were used to create risk indices for pancreatitis severity for all 13 variables which were included in a standard chart. RESULTS: The risk assessment rule's correct prediction is 81.32% (sensitivity) and 93.95% (specificity) for severe and mild pancreatitis, respectively. The total accuracy is 90.20%. CONCLUSION: The results of this nonstandard small retrospective study seem promising. It should remain experimental until larger prospective studies confirm the usefulness of the method.     

Alvarado scoring system in prediction of acute appendicitis

Objective: To evaluate the diagnostic accuracy of Alvarado score for the prediction of acute appendicitis. Study Design: Analytical study. Place and Duration of Study: This study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, during the period from January 15, 2009 to July 15, 2010. Methodology: The study included all adult patients of either gender who presented with clinical findings suggestive of acute appendicitis, who were assigned Alvarado score of < 4 pre-operatively and subsequently underwent emergency appendicectomy with histological examination of the resected specimens. Based on the Alvarado score, the patients were stratified into two groups. i.e. Group I (with a score of > 7) and Group II (with a score of 5-7). Alvarado score was compared with the histopathology. The data was subjected to statistical analysis to measure the objective. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score for acute appendicitis were 66%, 81%, 96%, 29% respectively. The sensitivity was higher though not significant, for males with a score over 7 than females with similar scores (97% vs. 92%). However, for scores less than 7, sensitivity among males was significantly higher than females with similar scores (79% vs. 61%; p < 0.05). Conclusion: The presence of a high Alvarado score in adult males is highly predictive of acute appendicitis, however, in women of child bearing age other causes of similar clinical presentation lead to a low diagnostic accuracy of the score.     

APACHE O评分系统对急性胰腺炎预后的评估价值

急性胰腺炎是一种常见的外科急腹症,病情复杂．预后差．APACHE Ⅱ评分系统是目前一较全面的多冈素预后评分系统,但仍存在一定局限性。APACHEO评分系统（APACHEⅡ评分加肥胖指标评分）是近年提出的一种急性胰腺炎预后评分系统日,本文旨在通过比较APACHE O评分与APACHEⅡ评分对急性重症胰腺炎的判断能力,对急性胰腺炎局部、全身并发症及死亡率的预测价值,旨在明确APACHE O评分系统对急性胰腺炎预后的评估价值.     

急性重症胰腺炎Binder综合评分及其预后

目的 了解急性重症胰腺炎(SAP)器官功能或代谢合并症Binder评分与SAP预后的关系。方法 对我院收治的112例SAP回顾调查，根据Binder积分和SAP并发症如休克、ARDS、胰性脑病和全身感染发生率与SAP死亡的关系，估计SAP的预后。结果 SAPll2例，治愈92例(82．1％)，死亡20例，病死率为17．8％，发生各种并发症73例(65．2％)。ARDS、休克、胰性脑病和全身感染，其病死率分别为6．3％、7．1％、5．3％和3．5％。按SAP器官或代谢合并症综合评分大于7分(或等于)组和评分小于7分组，综合评分大于7分组病死率非常显著高于评分小于7分组(P＜0．01)。结论 休克、ARDS、胰性脑病和全身感染是SAP主要并发症和死亡原因。Binder积分高低与其有关，积分越高，SAP预后越差，Binder评分高低不仅可以判定SAP病情轻重，而且估计SAP的预后。     

急性重症胰腺炎围手术期并发症与预后临床分析

目的探讨急性重症胰腺炎(severeacutepancreatitis,SAP)各种围手术期并发症与预后的关系。方法通过对我院近10年间行了外科手术治疗的116例SAP回顾调查,分析SAP围手术期各种并发症的发生率及其与SAP预后的关系。结果治愈85例(73.28%),死亡31例,病死率为26.72%;发生各种并发症232次,其中合并ARDS、胰性脑病、休克、腹腔出血和全身感染等并发症患者的病死率较高,分别为52%、40%、40.63%、66.67%和73.68。结论围手术期SAP并发症较多,严格掌握手术适应证特别重要;在各种并发症中ARDS、胰性脑病、休克、腹腔出血和感染等是死亡的主要原因。     

重症急性胰腺炎预后不良的相关危险因素分析

目的：探讨重症急性胰腺炎（SAP）预后不良的危险因素,为临床救治提供参考。方法：对118例SAP患者的临床资料进行回顾性分析,对SAP死亡的相关危险因素进行Logistic回归分析,筛选SAP死亡的相关危险因素。结果：单因素分析结果显示,肌酐（Cr）、血尿素氮（BUN）、空腹血糖（FBG）、血清白蛋白（ALB）与SAP早期死亡有关,而年龄、心率、呼吸、白细胞计数、平均动脉压（MAP）、总胆红素（TBIL）、直接胆红素（DBIL）、血淀粉酶（AMS）、尿淀粉酶（UAMY）等因素与SAP早期死亡无关（P〉0.05）。多因素Logistic回归法分析显示,FBG、Cr、ALB、BUN是SAP早期死亡的危险因素。结论：FBG、Cr、BUN水平升高,ALB水平下降是SAP预后不良的危险因素,需加以重点评估和合理控制。     

Pancreatic resection for severe acute pancreatitis

Non-operative management of acute necrotizing pancreatitis carries a mortality of up to 80 per cent. Over the last 6 years we have pursued an aggressive policy of intensive supportive therapy followed by pancreatic resection in those patients with this severe form of the disease. We have managed 15 patients in this way, 14 by subtotal pancreatic resection (usually body and tail of the gland) and one by total pancreatectomy; 7 had early overwhelming multi-system failure with a median of 4 positive prognostic factors whilst 8 were operated on later between 3 and 8 weeks (plus one at 32 weeks) and had varying clinical pictures. Eight patients had ischaemia of the transverse colon which was noted at operation in four, and presented postoperatively in the remainder. Re-operation was necessary in 13 patients to remove further slough or resect ischaemic bowel. Five patients (33 per cent) died between 10 days and 4 weeks postoperatively, death being due to sepsis and multi-system failure in four and a massive retroperitoneal haemorrhage in one. Of the ten survivors, four require insulin. Timely excision of necrotic pancreatic tissue combined with intensive supportive therapy may help reduce the high mortality in this condition.     

重症急性胰腺炎合并麻痹性肠梗阻的临床特点及其预后

目的:探讨重症急性胰腺炎(SAP)病程中麻痹性肠梗阻(PI)临床特点,分析其对预后的影响。方法:回顾性分析2011年2月—2012年3月间收治的45例SAP患者临床资料,其中合并P(ISAP+PI组)19例,无合并PI(SAP组)26例,分析SAP合并PI临床特点及其预后。结果:CT显示SAP+PI组积气积液(小肠或结肠)、巨大肠袢、肠管水肿发生率分别为100%,73.7%,78.9%,而SAP组无前2项表现,肠壁水肿发生率为50.0%(P=0.048);与SAP组比较,SAP+PI组胃潴留量,肠内营养不耐受(FI)发生率及黄疸发生率增加,腹腔压力增高、腹腔压力变化幅度增大(均P0.05);此外,SAP+PI组较SAP组住院时间、费用以及病死率明显增加(均P0.05)。单因素分析显示,FI,腹腔压力15 mmHg,黄疸,胃潴留量250 mL/d是影响SAP患者预后的重要因素(均P0.05)。结论:SAP合并PI的CT影像主要表现为积气积液与巨大肠袢等。SAP合并PI患者常伴有腹腔高压、黄疸、肠内营养不耐受、胃潴留等并发症,从而增加患者病死率。     

重症急性胰腺炎非手术治疗临床经验

目的 观察重症急性胰腺炎的非手术的治疗效果。临床资料 ３９例ＳＡＰ患者,其中非手术治疗１７例,病情Ｉ级１１例,Ⅱ级６例,死亡１例,手术治疗２２例,Ⅰ级９例,Ⅱ级１３例,死亡４例,结论多数ＳＡＰ可经非手术治疗治愈,对有胰腺组织坏死继发严重感染者则以引流为宜;经早期保守治疗而行延期手术者可简化手术方法,以减少术后并发症,提高手术耐受性     

Usefulness of the CLIP scoring system for prediction of postoperative prognosis of patients with large hepatocellular carcinoma

Background  Some patients with large hepatocellular carcinoma (HCC > 10 cm in diameter) have favorable surgical outcome, but the selection criteria are controversial. The relationship among various staging systems [(AJCC/UICC TNM classification, Liver Cancer Study Group of Japan TNM classification, the Cancer of the Liver Italian Program (CLIP) scoring system and the Japan Integrated Staging scoring system] and postsurgical prognosis of patients with large HCC is unknown. The aim of this study was to identify the staging system with the best prognostic value for such patients. Methods  The subjects of this retrospective study were 42 patients with large HCC. Various prognostic factors were assessed by multivariate analysis. The disease state was staged by the above four staging systems. The accuracy of prediction of 1-year, 3-year and 5-year mortality for each system was evaluated by the area under the receiver operating characteristic curve. Results  Serum α-fetoprotein and curability were identified by multivariate analysis as the only significant prognostic factors. The discriminatory ability of the CLIP scoring system was superior to other systems. Patients with CLIP scores <2 had better prognosis (score = 0, 100% of 1-year survival rate; score = 1, 75%) than those with scores >2 (score = 2, 3 and 4; 50%, 46% and 33%, respectively). Conclusions  The CLIP scoring system is the best for classifying patients with large HCC and prediction of their prognosis after surgery.