急性胰腺炎危重程度评估方法的研究

急性胰腺炎(acute pancreatitis, AP)是临床常见的急腹症之一,死亡率一直居高不下.近数十年在AP的诊治等方面虽均有进步,但仍有20%～30%的患者临床经过凶险,总体死亡率达5%～10%[1].AP分为轻症急性胰腺炎(mild acute pancreatitis, MAP)及重症急性胰腺炎(severe acute pancreatitis,SAP),MAP病情相对较轻,预后较好,而SAP常引起严重的全身或局部并发症,病死率高.     

危重型急性胰腺炎的研究进展

危重型急性胰腺炎（CAP）是并发持续性器官功能衰竭和感染性胰腺坏死的一类急性胰腺炎（AP）。尽管其在AP中所占的比例较低,但病死率和并发症发生率极高,是最为凶险的AP分型。目前,国内外文献对CAP的研究报道不多,临床的认识和实践亦不足。笔者通过文献复习并充分结合本中心的前期临床研究和实践,对CAP的研究进展进行深入解读和探讨,以期引起胰腺外科同行的进一步关注,不断提高CAP的诊治水平,降低病死率。     

超声评分对急性胰腺炎重症程度的评估价值

目的：探讨超声评分评估急性胰腺炎严重程度的价值。方法：回顾性分析116例重型急性胰腺炎患者的超声声像图,按各种征象存在与否予以评分并分组,并将结果与临床资料作对照研究。结果：平均住院天数、手术例数随超声评分增高而呈增长,超声评分≥9分组病死率及手术率明显高于其他3组（P＜0.05）;超声评分≥6分为重症。结论：应用超声评分法评估急性胰腺炎严重程度,快速简便、准确性较高。     

重症急性胰腺炎：急性胰腺炎严重程度分类法研究的进展

近２０多年来,急性胰腺炎的严重度评估和临床诊治一样有了很大的发展。这是由于急性胰腺炎病情的变化迅速,严重病人的预后凶险,单凭临床经验难以正确估计,严重度的评估有利于了解病情,以指导临床治疗,因而具有十分重要的临床意义。急性胰腺炎严重度估计的研究经历了３个阶段,全身评分系统的研究、局部估计的研究以及多器官功能不全（ＭＯＤＳ）评分系统的研究,以下从这三个方面论述。也有学者曾经研究过血清标记物,希望用Ｃ反应蛋白、中性粒细胞弹力蛋白酶和胰蛋白酶激活肽等单项生化指标评估严重度,但都未能证明有效地鉴别诊断胰…     

危重型急性胰腺炎进一步分型价值研究

目的探讨危重型急性胰腺炎(CAP)进一步分型的价值。方法回顾性分析2010年1月至2021年2月中南大学湘雅医院胰腺外科收治的120例CAP病人的临床资料。根据CAP病人器官功能衰竭和感染性胰腺坏死是否同期发生,分为同时性CAP(69例)和异时性CAP(51例)两组,比较两组病人临床结局的差异。结果全组病死率为42.5%(51/120),其中同时性CAP病死率为66.7%(46/69),高于异时性CAP组(9.8%,5/51),差异具有统计学意义(P<0.05)。与异时性CAP相比,同时性CAP病人多器官功能衰竭发生率更高、器官功能衰竭持续时间更长、术后出血发生率更高、ICU住院时间及总的住院时间明显延长(均P<0.05)。多因素Logistic回归分析显示,起病至IPN时间(OR=1.1,95%CI 1.0-1.2,P=0.010)、多器官功能衰竭(OR=8.3,95%CI 2.1-32.2,P=0.002)和同时性CAP(OR=9.4,95%CI 2.6-34.5,P=0.001)是CAP病人死亡的独立预后因素。结论同时性CAP是早期器官功能衰竭进行的同时并发感染性胰腺...     

早期判断急性胰腺炎严重程度的方法探讨

目的:探讨早期判断急性胰腺炎严重程度的简便实用方法.方法:对1995～1996年收治的108例急性胰腺炎病例作回顾性分析.结果:体温≥38℃、血糖≥11.2mmol/L、血钙≤2mmol/L及胰外侵犯的出现可组成重症胰腺炎的预测体系,每一阳性指标计1分,≥2分者列为重症,其在本研究中的敏感性、特异性及准确性分别达95%、89.47%和91.53%.结论:该体系结合了急性胰腺炎的临床生化和形态学特点,较为简便、实用,入院早期即可作出判断.     

三种CT评分与急性胰腺炎严重程度床边指数评分评估重症急性胰腺炎的相关性研究

目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)患者三种CT评分即CT严重指数(CT severity index,CTSI)、修正CT严重指数(modified computed tomography severity index,MCTSI)、胰腺外炎症CT(extra-pancreatic inflammation on CT,EPIC)评分分别与急性胰腺炎严重程度床边指数(bedside index of severity in acute pancreatitis,BISAP)的相关性。方法前瞻性收集2015年7~11月期间确诊为急性胰腺炎的患者135例,纳入其中诊断为SAP的患者45例,对其采用三种CT评分标准(CTSI、MCTSI及EPIC)和BISAP评分标准进行评分,分析三种CT评分结果与BISAP评分结果的相关性。对于CTSI、MCTSI及EPIC评分在两位观察者间的一致性用Kappa检验分析。MCTSI、CTSI及EPIC分别与BISAP的相关性用Spearman等级相关分析。检验水准α=0.05。结果 BISAP评分Ⅰ级者4例,Ⅱ级者22例,Ⅲ级者19例,总评分为(2.41±0.82)分。CTSI的评分结果为Ⅰ级者6例,Ⅱ级者22例,Ⅲ级者17例,总评分为(6.02±1.96)分,两位观察者间一致性好(Kappa=0.748,95%CI为0.000~0.076,P0.01)。MCTSI的评分Ⅰ级者1例,Ⅱ级者13例,Ⅲ级者31例,总评分为(7.91±2.11)分,两位观察者间一致性好(Kappa=0.788,95%CI为0.000~0.076,P0.01)。EPIC评分结果为:Ⅰ级者6例,Ⅱ级者11例,Ⅲ级者28例,总评分为(5.57±1.52)分,两位观察者间一致性好(Kappa=0.768,95%CI为0.000~0.076,P0.01)。CTSI、MCISI、EPIC评分分别与BISAP评分均呈正相关(rs=0.439,P=0.003;rs=0.640,P=0.000;rs=0.503,P=0.001)。结论胰腺炎三种CT评分与BISAP均趋于正相关,MCTSI和EPIC与BISAP相关性较好,且MCTSI与BISAP较EPIC与BISAP的相关性更好。     

急性胰腺炎严重程度分类的研究现状

正急性胰腺炎(acute pancreatitis,AP)是临床上常见的内外科急症,发病率位居急腹症的第3~5位,且有逐年上升的趋势~[1-3],总体病死率4.6%,重症患者病死率可高达15.6%~30%~[4],AP的严重程度不同会造成患者在临床特征和转归上很大的差异~[5]。如果能够及早对AP严重程度进行分类,就能够及时发现危重患者,并进行合理治疗,进而降低患者的病死率。     

重症急性胰腺炎早期危重并发症的诊治

目的:探讨影响重症急性胰腺炎治疗效果的关键因素是早期的危重并发症。结果:本组162例,治愈160例,治愈率98.8％,死亡2例,死亡率1.2％。结论:重症急性胰腺炎病人早期并发休克、肾功能不全、ARDS、胰性脑病和感染是导致死亡的关键因素。     

重症急性胰腺炎外科手术的评估

目的：总结近８年来重症胰腺炎的治疗经验。方法：分非手术和手术二组、二组病人均在ＩＣＵ监护和治疗，分析二组病人治疗后的疗效。结果：手术组３３例，死亡１１例（３２．４％），术后出现各种并发症和器官功能衰竭１５例（４４％），平均住院天数８７天。非手术组２０例，死亡２例（１０％），并发症９例（４５％），平均住院３４天。结论：对ＳＡＰ采用早期外科手术的观点应当改变。外科手术在ＳＡＰ中的指片应是梗阻性胆源性胰     

Evaluation of severity in acute pancreatitis

Recently we reviewed 240 patients with acute pancreatitis admitted to our service and the affiliated hospitals for five years. Clinical symptoms and laboratory data of these cases were analyzed depending on their prognosis. The grades were divided into 3 groups by the mortality rates: Grade I with the mortality rate of less than 10%, Grade II 10-20%, and Grade III with greater than 20%. Clinical symptoms in Grade III were shock and neurological or dermatological symptoms. On the other hand, laboratory findings in Grade III were as follows; blood sugar was more than 200 mg/dl, LDH greater than or equal to 600 IU%, BUN greater than or equal to 40 mg/dl, serum Ca less than or equal to 7.5mg/dl, T.Bil. greater than or equal to 5.0 mg/dl, blood pressure less than or equal to 90 mmHg, and PaO2 less than or equal to 65 mmHg (room air). The degree of severity of acute pancreatitis was divided into 3 types, as follows: Mild; all belong to Grade I, or less than 2 positives of Grade II. Moderate; 3 to 4 positives of Grade II, or one positive of Grade III. Severe; 5 positives or more of Grade II, or 2 positives or more of Grade III. Our criteria with both clinical and laboratory findings are very useful for the evaluation of the severity and choice of treatment in acute pancreatitis.     

Predictors of severity of attacks of acute pancreatitis

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH and PO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.     

JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis: (1) Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis (Recommendation A). (2) Assessment by a severity scoring system (JPN score, APACHE II score) is important for determining treatment policy and identifying the need for transfer to a specialist unit (Recommendation A). (3) C-reactive protein (CRP) is a useful indicator for assessing severity (Recommendation A). (4) Contrast-enhanced computed tomography (CT) scanning and contrast-enhanced magnetic resonance imaging (MRI) play an important role in severity assessment (Recommendation A). (5) A JPN score of 2 or more (severe acute pancreatitis) has been established as the criterion for hospital transfer (Recommendation A). (6) It is preferable to transfer patients with severe acute pancreatitis to a specialist medical institution where they can receive continuous monitoring and systemic management.     

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急性胰腺炎的严重程度分级对临床实践和研究具有重要的意义。国际胰腺病协会通过广泛的专家讨论,把对急性胰腺炎病情变化有决定性影响的因素分成局部和全身因素。局部影响因素指胰腺或胰腺周围组织的坏死,统称为围胰腺坏死;全身影响因素系指由急性胰腺炎引起的远处器官功能异常,即器官功能衰竭。通过将不同严重程度的局部和全身因素的组合,将急性胰腺炎分成轻度、中度、重度、危重四级。该分级系统的特点是依据临床现实的危险因素确定急性胰腺炎的严重程度,而不是一些生化和生理指标。本分级系统的基础是大量的回顾性分析,尚需前瞻性研究验证。     

CT score and the severity of acute pancreatitis

The CT findings in 28 patients with acute pancreatitis were compared with the severity of the disease. The pancreatic image, which demonstrates the pancreatic lesion, was studied with respect to 9 items, and fluid accumulation showing the peripancreatic status with respect to 13 items. According to Forell's classification, the lesion was mild in 8 patients, moderate in 11, and severe in 9. The detection rates of abnormal pancreatic images and fluid accumulation increase with the advance in the severity of the disease. The mean CT score according to severity was 0.9 +/- 0.6 for mild pancreatitis, 7.2 +/- 4.5 for moderate pancreatitis, and 13.4 +/- 4.2 for severe pancreatitis. Significant differences were observed among the groups, suggesting that the CT score is useful for evaluating the severity of acute pancreatitis.     

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。