摘要目的 评价新的急性胰腺炎(AP)分类标准的临床应用价值.方法 回顾性分析78例原诊断为重症急性胰腺炎(SAP)患者的临床资料,按新的分类标准将其细分为中度急性胰腺炎(MSAP)组(57例)和重度急性胰腺炎(SAP)组(21例).记录两组患者的性别,年龄,病因,入院后的实验室和影像学检查,APACHEⅡ、Ranson、SIRS、改良Marshall、JSS、BISAP、Imrie评分,胃肠减压天数,入住ICU天数,住院总天数,外科干预例数,病死率,住院总费用等.结果 入院时两组患者的性别比、病因、血细胞比容、SIRS评分的差异均无统计学意义(P＞0.05).SAP组患者入院时血肌酐、血尿素氮、血乳酸脱氢酶水平及APACHEⅡ、Ranson、改良Marshall、JSS、BISAP、Imrie评分分别为(157.13±101.60) μmol/L、(10.38±7.43) mmol/L、(780.62±645.01) IU/L和(13.71±5.03)、(5.14±2.15)、(5.48±2.36)、(4.62±1.63)、(2.57±0.60)、(4.71±1.27)分；MSAP组分别为(71.85±27.90) μmol/L、(4.71±2.57) mmol/L、(337.70±177.77)IU/L和(7.39±3.91)、(2.49±1.56)、(0.81±0.85)、(2.21±1.37)、(1.68±0.81)、(2.77±1.24)分,两组差异均有统计学意义(P值均＜0.05).SAP组患者均有持续性器官功能衰竭,单器官功能衰竭8例,多器官功能衰竭13例,9例患者病死；MSAP组患者均治愈出院.SAP组患者入住ICU例数及入住平均天数、住院总天数、住院总费用分别为11例、(8.10±13.67)d、(45.8±45.5)d、(11.41±16.67)万元；MSAP组分别为2例、(0.16±0.88)d、(26.3±19.7)d、(3.62±2.93)万元,两组差异均有统计学意义(P值均＜0.05).结论 按新的AP分类标准将重症急性胰腺炎分为MSAP、SAP有助于临床医师更准确地评估患者的病情及预后.

abstractsObjective To evaluate the clinical significance of a new classification of acute pancreatitis.Methods Seventy-eight patients with severe acute pancreatitis were retrospectively studied,and according to the new classification,these pancreatitis were further divided into moderately severe acute pancreatitis (MSAP) group (n =57) and severe acute pancreatitis (SAP) group (n =21).The sex ratio,age,etiology,laboratory and imaging examination after admission,APACHE Ⅱ score,Ranson score,SIRS score,modified Marshall score,JSS score,BISAP score,Imrie score,days of gastrointestinal decompression,ICU stay,hospital stay,number of surgical interventions,mortality,hospitalization expenses were documented in these two groups of patients.Results Upon admission,the sex ratio,etiology,hematocrit and SIRS score was not statistically significantly different between the two groups (P ＞ 0.05).The serum creatinine,blood urea nitrogen,lactate dehydrogenase,APACHE Ⅱ score,Ranson score,modified Marshall score,JSS score,BISAP score,and Imrie score of SAP group were (157.13 ± 101.60) μμmol/L,(10.38 ± 7.43) mmol/L,(780.62±645.01)IU/L,(13.71±5.03),(5.14±2.15),(5.48±2.36),(4.62±1.63),(2.57±0.60),(4.71 ± 1.27),and the corresponding values in MSAP group were (71.85 ± 27.90) μmol/L,(4.71 ±2.57)mmol/L,(337.70± 177.77)IU/L,(7.39±3.91),(2.49±1.56),(0.81±0.85),(2.21 ± 1.37),(1.68 ±0.81),(2.77 ± 1.24),and the difference between the two groups was statistically significant (P ＜ 0.05).All patients in SAP group had persistent organ failure,eight patients had single organ failure and thirteen patients had multiple organ failure,and nine patients died.All patients in MSAP group were cured and discharged.The number of patients in SAP group who were admitted in ICU,ICU stay,hospital stay,hospitalization expenses were 11,(8.10 ± 13.67) d,(45.8 ± 45.5) d,(114.1 ± 166.7)thousands RMB,and the corresponding values in MSAP group were 2,(0.16 ± 0.88) d,(26.3 ± 19.7) d,(36.2 ± 29.3) thousands RMB,and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions The new classification system which divides AP into MAP,MSAP,SAP can help clinicians better evaluate the severity and prognosis of patients with AP.