中度急性胰腺炎临床特征分析

目的探讨中度急性胰腺炎的临床特征。方法回顾性分析2013年1月至12月，青海省交通医院普通外科收治的103例急性胰腺炎（acute pancreatitis，AP）患者临床资料，根据国际AP专题研讨会最新修订的诊断和分类标准（2012年，美国亚特兰大）诊断为轻度急性胰腺炎（mildacutepancreatitis，MAP）61例、中度急性胰腺炎（moderately severe acute pancreatitis，MSAP）25例、重度急性胰腺炎（severe acute pancreatitis，SAP）17例，对比三组患者一般资料、局部并发症发生此例、器官功能衰竭发生比例、入住ICU比例和天数、干预措施、住院天数、病死率。结果三组患者性别、年龄和病因学情况差异均无统计学意义，但MSAP组APACHEⅡ评分显著高于MAP组，同时低于SAP组（均P〈0．05）。MAP、MSAP和SAP三组出现局部并发症的比例分别为0、92．0％（23125）和76．5％（13／17）（P〈0．05）。MAP组无器官功能表竭发生，MSAP组5例出现一过性（〈48h）器官功能表竭，SAP组均出观特续性（〉48h）器官功能衰竭，SAP组器官功能衰竭比例显著高于MSAP组（P〈0．05）。MAP组无入住ICU病例，均无需介入、内镜或外科干预，无死亡病例。MSAP组入住ICU此例、ICU时间、住院时间和病死率显著低于SAP组（P〈0．05）。结论中度急性胰腺炎为有别于轻度和重度急性胰腺炎的独立类型，伴有局部并发症或一过性（48h内）器官功能表竭，但病死率较低，预后明显好于重度急性胰腺炎。

Analysis on the clinical features of moderately severe acute pancreatitis

Objective To investigate the clinical features of moderately severe acute pancreatitis （MSAP）. Methods The clinical data of patients with acute pancreatitis （AP） admitted in our hospital between Jan. 2013 and Dec. 2013 were retrospectively reviewed. Patients were divided into mild acute pancreatitis （MAP, n=61）, moderately severe acute pancreatitis （MSAP, n=25）, and severe acute pancreatitis （SAP, n=17） groups according to the international classification of acute pancreatitis （Atlantic, 2012）. The scores in the acute physiology and chronic health evaluation （APACHE） Ⅱ during admission, local complications, organ failure, ratio and duration for intensive care unit （ICU） care, total ICU days, total hospital stay, need for interventions, and death rates among the 3 groups were compared retrospectively. Results The scores in APACHE Ⅱ were significantly different among the 3 groups （P〈0.05）. The rates of patients with local complications were 0 in MAP, 92.0% （23/25） in MSAP and 76.5% （13/17） in SAP respectively （P〈0.05）. In the SAP group, all patients had persistent organ failure. While only 5 patients developed transient organ failure in the MSAP group. Compared with patients with MAP, patients with MSAP had a significantly longer hospital stay. Compared with those with SAP, a significantly smaller proportion of patients with MSAP requireing for ICU care, total hospital stay and need for interventions were similar. None of the MSAP patients died compared with 41.2% death rate in SAP group （P 〈0.05）. Conclusion MSAP is characterized by AP with local complications and transieat organ failure, and which is associated with lower morbidity than that of SAP, a better prognosis.