修订全身炎症反应综合征标准早期判断重症急性胰腺炎及其预后

目的　探讨全身性炎症反应综合征 (Systemicinflammatoryresponsesyndrome ,SIRS)在急性胰腺炎 (Acutepancreati tis ,AP)中的发生情况 ,尝试建立修订全身性炎症反应综合征 (Modifiedsystemicinflammatoryresponsesyndrome ,MSIRS)标准 ,应用MSIRS早期判断重症急性胰腺炎 (Severeacutepancreatitis ,SAP)及其预后。方法　收集我院 1998年 1月～2 0 0 2年 2月收治的 2 81例急性胰腺炎的临床资料 ,统计分析轻型急性胰腺炎 (Mildacutepancreatitis ,MAP)和SAP患者发病 48小时内的SIRS指标水平 ;修改SIRS标准水平 ,探索MSIRS标准早期判断SAP的优越性以及和SAP预后间的关系。结果　 ( 1)SIRS在AP中总发生率为 41.2 %,其中MAP发生SIRS为 18.1%,SAP则 10 0 %发生SIRS ;( 2 )建立MSIRS标准 :T >38℃ ,P >110次 /min ,R >2 2次 /min ,WBC >15 .0× 10 9/L ,符合 2项或 2项以上者 ,判断为SAP ;( 3)与临床诊断金标准比较 ,MSIRS标准早期判断出SAP的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为 :91.89%、93.6 2 %、93.13%、85 %和 96 .7%。 ( 4 )SAP患者除胰腺并发症外 ,急性呼吸窘迫综合征 (Acuterespiratorydistresssyndrome ,ARDS)、多器官功能不全综合征 (Multipleorgandysfunctionsydrome ,MODS)及?

Modified Criteria for Systemic Inflammatory Response Syndrome Judging Severe Acute Pancreatitis and Its Prognosis

Objective To explore systemic inflammatory response syndrome(SIRS) occurred in the patients with acute pancreatitis(AP),and try to establish the modified criteria for systemic inflammatory response syndrome(MSIRS) in order to judge the severe acute pancreatitis(SAP) and predict the prognosis.Method 281 cases of AP were collected and the recordings of SIRS indexes were analyzed in the groups of mild acute pancreatitis (MAP) and SAP within 48 hours after the onset of illness.The criteria of SIRS was modified and the superiority of MSIRS criteria in judging SAP and its relationship to the prognosis of SAP was studied.Results (1)The incidence of SIRS was 41.2% in AP,18.1% in MAP and 100% in SAP respectively.(2)The established MSIRS criteria were as follows:T>38℃,P>110/min,R>22/min,WBC>15.0×10 9/L,the patients fit in with more than two of the criteria were determined as SAP.(3)Comparing with the golden standard,the sensibitity,specificity,accurate rate,positive predictive value and nagative predictive value of MSIRS criteria for SAP were 91.89%,93.62%,93.13%,85% and 96.7% respectively.(4)Except the complication of pancreas,the incidence of acute respiratory distress syndrome(ARDS),multiple organ dysfunction sydrome(MODS),and fatality rate all increased along with the increase of the observed items to the MSIRS criteria.Conclusions SIRS plays an important role in AP,MSIRS criteria posses high sensibitity,specificity and accurate rate in judging SAP,and are related to the incidence of ARDS,MODS and death.