2012年版急性胰腺炎分类标准的临床应用

Clinical application of the Classification of acute pancreatitis-2012

目的初步探讨2012年版急性胰腺炎分类标准的临床应用价值。方法回顾性分析2009年10月至2012年9月广西医科大学第一附属医院诊断为急性胰腺炎患者的临床资料。根据2012年版分类标准将患者分为轻症急性胰腺炎（MAP）、中度重症急性胰腺炎（MSAP）、重症急性胰腺炎（SAP）3组。比较各组患者的好转及治愈例数、住院天数、住院费用、ICU入住率及入住天数、SIRS发生率及持续天数、Ranson评分、APACHEⅡ评分、CTSI评分的差异有无统计学意义。结果166例患者中MAP76例，MSAP65例，SAP25例；男性119例，女性47例；平均年龄（49±15）岁；平均人院前发病时间为（2．27±1．46）d。3组患者的好转及治愈例数、住院天数、住院费用、人住ICU例数及天数、SIRS发生例数及持续天数、Ranson评分、APACHEⅡ评分、CTSI评分均随着疾病严重程度的增加而升高（P值均〈0．01），其中SAP组患者相应值分别为21例（84．0％）、（23．8±13．6）d、（53900±30260）元、12例（48．0％）及（5．76±13．8）d、24例（96．0％）及（5．00±2．40）d、（3．76±1．30）分、（8．52±4．24）分、（5．44±3．48）分。166例患者中79例发生局部并发症，其中急性胰周液体积聚34例，急性坏死物积聚45例。SAP组急性坏死物积聚发生率高于MSAP组（68．0％比44．6％，P=0．047），而急性胰周液体积聚发生率低于MSAP组（16．0％比46．1％，P=0．016）。166例患者中42例发生器官功能衰竭，其中35例发生呼吸功能衰竭，2例发生肾功能衰竭，5例合并发生呼吸功能和肾功能衰竭。SAP组器官功能衰竭发生率为100％，MSAP组为26．2％，两组差异有统计学意义（P〈0．05）。结论2012年版急性胰腺炎分类标准简便易行，能准确反映急性胰腺炎的严重程度，适于临床应用。

Objective To investigate the clinical value of the Classification of acute pancreatitis- 2012. Methods Medical records and clinical data of patients with acute pancreatitis （AP） who were admitted to First Affiliated Hospital of Guangxi Medical University between October 2009 and September 2012 were retrospectively reviewed and analyzed. Patients were divided into mild acute pancreatitis （MAP） , moderately severe acute pancreatitis （MSAP）, and severe acute pancreatitis （SAP） groups according to the Classification of acute pancreatitis-2012. The number of improved and cured patients, length of hospital stay, hospitalization costs, rate of ICU admission, length of ICU stay, incidence of SIRS, and length of SIRS continue, Ranson scores, APACHE [[ scores, computed tomographic severity index （ CTSI ） scores among the 3 groups were compared. Results One hundred and sixty-six patients with AP （119 males and 47 females） were included, and 76 were MAP, 65 MSAP and 25 SAP. The average interval between AP onset and hospital admission was （2.27 ± 1.46） d. The number of improved and cured patients, length of hospital stay, hospitalization costs, rate of ICU admission, length of ICU stay, incidence of SIRS, and length of SIRS continue, Ranson scores,APACHE Ⅱ scores, CTSⅠ scores increased with the severity of AP. The corresponding values in SAP group were 21 cases （ 84.0% ） , （23.8 ± 13.6） d, （53900 ± 30260） Yuan, 48.0% （ 12/25 ） and （5.76 ±13.8 ） d, 96.0% （24/25） and （ 5.00 ± 2.40） d, （ 3.76 ± 1.30） score, （ 8.52 ± 4.24） score, （ 5.44 ± 3.48 ） score. Seventy-nine patients developed local complications, among them 34 was acute peripancreatic fluid collection, 45 was acute necrosis collection. The incidence of acute necrosis collection in SAP group was significantly higher than that in MSAP group （ 68.0% vs 44.6%, P = 0. 047 ）, but the incidence of acute peripancreatie fluid collection in SAP group was significantly lower than that in MSAP group （16.0% vs 46.2%, P = 0.016 ）. Organ failure occurred in 42 patients, among them 35 cases were respiratory failure, 2 cases were renal failure, and 5 cases were respiratary and renal failure. The incidence of organ failure in SAP and MSAP group was 100% and 26.2%, the difference between the two groups was statistically significant （P 〈 0.05 ）. Conclusions Classification of acute pancreatitis-2012 is a simple and convenient system, which can predict the severity of AP and appropriate for clinical application.