BISAP评分在重症急性胰腺炎预后评估中的应用价值

Application value of BISAP score in evaluating the prognosis of severe acute pancreatitis

【摘要]目的研究床旁急性胰腺炎严重度评分（BISAP）对重症急性胰腺炎（SAP）预后的评估价值。方法收集2009年4月～2013年2月我院收治的47例SAP患者的临床资料，分别记录患者的年龄、意识障碍、全身炎症反应综合征（SIRS）、血尿素氮、胸膜渗出5个指标进行BISAP评分，分析BISAP评分对器官功能衰竭及胰腺坏死的预测价值及其与病死率的关系。结果47例SAP患者中，15例出现器官功能衰竭，发生率31．91％；23例患者出现不同程度的胰腺坏死，发生率48．94％。BISAP评分在出现器官功能衰竭或胰腺坏死的患者中，与未出现的患者相比，差异均有统计学意义（P值分别为0．000和0．005）。受试者工作特征（ROC）曲线评估器官功能衰竭和胰腺坏死的曲线下面积（AUC）分别为0．857（95％CI：0．740～0．974）和0．732（95％CI：0．584～0．880），取3分为最佳截点值，低分组（〈3分）患者全部存活，高分组（≥3分）死亡6例，差异有统计学意义（P=O．000）。结论BISAP评分对预测SAP患者出现器官功能衰竭和胰腺坏死具有较高价值。是早期评估SAP预后的良好指标，值得在临床上推广应用。

Objective To evaluate the value of bedside index for severity in acute pancreatitis （BISAP） score in pre- dicting the prognosis of severe acute pancreatitis （SAP）. Methods The data from forty-seven patients with SAP, admit- ted into our hospital from April 2009 to February 2013 were collected, calculated with BISAP by recording five index- es： such as the patients age, disorder of consciousness, systemic inflammatory response syndrome （SIRS）, blood urea nitrogen, and pleural effusion, evaluate the predictive value of BISAP score system to organ failure and pancreatic necrosis, and the correlation between mortality of severe acute pancreatitis and BISAP score system. Results Fifteen patients had organ failure, the incidence was 31.91%, twenty-three cases had varying degrees of pancreatic necrosis, and the incidence was 48.94%. The differences of BISAP score were statistically significant between patients who ap- peard with organ failure or pancreatic necrosis, compared with who were not （P = 0.000 and 0.005）. The areas under ROC curve （AUC） for evaluate organ failure and pancreatic necrosis were 0.857 （95%C1：0.740-0.974） and 0.732 （95% CI：0.584-0.880）, taking three points as the optimal cut-off value, low score group （〈 3） patients all survived, but six eases died in the high seore group （〉I 3）, both were significant differences （P=0.000）. Conclusion B1SAP seore system can be used to predict the organ failure and pancreatic necrosis of severe acute pancreatitis, and had a good value to assess prognosis, which should be widely used.