重症急性胰腺炎新分类再评价的单中心临床研究

目的 探讨新的急性胰腺炎（AP）分类标准的临床应用价值.方法 回顾性分析2005年1月至2012年12月收治的649例重症急性胰腺炎（SAP）患者资料,按新的分类标准将其分为中度AP（MSAP）和重度AP（SAP）,比较两组患者的Ranson、APACHEⅡ、BISAP、MCTSI、Marshall评分,器官衰竭发生率,临床治疗情况,预后及病死率.结果 649例传统分类的SAP患者按照新分类标准分为MSAP559例和SAP 90例.两组患者的性别、年龄、病因差异均无统计学意义.新分类的MSAP患者入院时的Ranson、APACHEⅡ、BISAP、MCTSI、Marshall评分分别为（1.5±1.3）、（7.6±4.8）、（1.6±0.9）、（6.0±1.8）、（0.0±0.4）分,新分类的SAP患者分别为（3.4±1.7）、（16.8±5.7）、（2.7±0.9）、（6.9±2.1）、（4.3±2.0）分,两组差异均有统计学意义（P值均＜0.01）.MSAP患者发生呼吸衰竭1例次,肾脏衰竭1例次,循环衰竭0例次,发生2个脏器衰竭0例,3个脏器衰竭1例,新分类的SAP患者分别为30、23、l例次和20、11例,两组差异具有统计学意义（P值均＜0.01）.新分类的SAP患者需要入住的重症监护病房（ICU）、血液净化、机械通气、介入引流、外科手术等例数的百分比均显著高于MSAP组,且需要时间也长于后者,两组间的差异均有统计学意义（P值均＜0.01）,但两组患者需要肠内营养支持的例数差异无统计学意义.新分类的SAP患者的院内病死率为35.6％（32/90）,显著高于MSAP组的2.0％（11/559）,平均住院时间为（36.3 ±30.2）d,也显著长于MSAP患者的（23.0±18.8）d,两组间的差异均具有统计学意义（P值均＜0.01）.结论 采用新的AP分类方法能更精确地反映病情的严重程度,更准确地判断预后并指导临床治疗.

A single-center study of clinical re-evaluation of the new classification of acute pancreatitis

Objective To evaluate the clinical values of the new classification of acute pancreatitis. Methods A total of 649 traditional severe acute pancreatitis （SAP） patients, who were admitted to the Changhai Hospital from January 2005 to December 2012, were retrospectively studied. According to the new classification, these patients were divided into moderately severe acute pancreatitis （MSAP） and severe acute pancreatitis （SAP）, and then the Ranson, APACHE H, BISAP, MCTSI scores l Marshall scores, incidence of organ failure, clinical treatment, prognosis and mortality in the two groups were compared. Results Among 649 traditional SAP patients, 90 patients were diagnosed to have SAP and 559 were diagnosed as MSAP according to the new classification criteria. The sex ratio, age and etiology were not significantly different between the 2 groups. The Ranson, APACHE II, BISAP, MCTSI, Marshall scores of MSAP patients were （ 1.5 ± 1.3 ）, （7.6 ± 4.8）, （ 1.6 ± 0.9）, （6.0 ± 1.8）, （0.0 ± 0.4）, and the corresponding values in SAP groupwere （3.4±1.7）, （16.8±5.7）, （2.7±0.9）, （6.9±2.1）, （4.3±2.0）, and the difference between the two groups was statistically significant （P〈0.01）. Respiratory failure, renal failure, cardiovascular failure, 2 organs failure, 3 organs failure occurred in 1, 1, 0, 0 and 1 patient, and the corresponding values were 30, 23, 1, 20, 11 patients, and the difference between the two groups was statistically significant （ P 〈 0.05）. The needs of ICU admission, blood purification, mechanical ventilation, interventional drainage were significantly higher in SAP patients than those in MSAP patients, and the time was much longer than that in MSAP patients, and the surgical management rate was also significantly higher than that in MSAP patients, and the difference between the two groups was statistically significant （ P 〈 0.01 ）. The rates of enteral nutrition in the two groups were not statistically significant. The mortality rate of the SAP patients was 35.6% （32/90）, which was significantly higher than that of MSAP patients （2.0%, 11/559）. The median hospital length of SAP patients was （ 36.3 ± 30.2） d, which was significantly longer than （23.0 ± 18.8） d of MSAP patients, and the difference between the two groups was statistically significant （P 〈 0.01 ）. Conclusions The introduction of new classification method can better reflect the severity of disease, more accurately predict prognosis and guide clinical management.