APACHEⅡ评分系统在重症急性胰腺炎预后评估中的应用

Value of APACHEⅡ scoring system in predicting the prognosis of severe acute pancreatitis

目的:探讨急性生理和慢性健康状况评分(APACHEⅡ)系统对重症急性胰腺炎(SAP)患者预后评估的价值.方法:回顾2004-2007年四川大学华西医院收治的SAP患者300例临床资料,进行APACHEⅡ评分,分析各个结局的APACHEⅡ评分,计算入院后d1、3、7的评分与对应的病死率并进行相关分析,APACHEⅡ评分以8,9,10,11分为临界值时对死亡的预测结果.结果:死亡和胰腺局部并发症患者APACHEⅡ评分与治愈患者评分相比有差异(P=0和0.001<0.01),随着APACHEⅡ评分增加,病死率亦随之增加.患者d1、3、7的评分和病死率均呈正相关,d3患者的评分值高低与死亡相关性最高.24hAPACHEⅡ评分10分为临界点时对评估SAP患者预后效果最佳.结论:APACHEⅡ评分可动态评估患者病情变化,对预测预后以及指导临床有重要意义。

AIM： To evaluate the value of APACHEⅡ scoring system in predicting the prognosis of severe acute pancreatitis （SAP）. METHODS： Three hundred consecutive SAP patients, admitted into West China Hospital of Sichuan University from 2004 to 2007, were studied retrospectively. Data associated to APACHE Ⅱ scoring system were recorded. We analyzed the APACHE Ⅱ score of the patients with various outcomes and the relationship between the mortality and APACHE Ⅱ score on the 1th, 3th and 7th day. The prediction results of dead and survived patients using 8, 9, 10, and 11 scores as the cut off points were also analyzed. RESULTS： The APACHE Ⅱ score between the dead patients or patients with local complications and recovered patients showed significant differences （P = 0 and 0.001 〈 0.01）. The mortality rate increased with the growing APACHE Ⅱ score. The APACHE Ⅱ score on the 1th, 3th and 7th day was positively correlated with mortality rates. And the correlation on the 3rd day was the strongest. The APACHE Ⅱ score within 24 h no less than 10 score was the best cut off point to predict the prognosis of SAP. CONCLUSION： APACHE Ⅱ scoring system can dynamically predict the changes of SAP and play a very important role in assessing prognosis and guiding therapy.