急性胰腺炎《修订版亚特兰大分类标准》的应用评价

Validation of the revised Atlanta classification and the determinant-based classification for severity of acute pancreatitis

目的 验证急性胰腺炎（AP）《修订版亚特兰大分类标准》（RAC）和《基于重要临床影响因素的急性胰腺炎严重程度分类标准》（DBC）在AP严重程度判断中的准确性.方法 回顾分析2014年1月至2014年10月入院的AP患者临床资料.依据RAC和DBC分类标准,分别计算各亚组AP患者全胃肠外营养时间、ICU停留时间、住院时间、手术率及病死率.结果 在192例资料完整的患者中,38.5％ （74/192）的患者出现胰腺或胰周液体积聚,26.6％ （51/192）出现胰腺或胰周组织坏死,9.4％ （18/192）出现继发感染.依据RAC分类标准,分别有55.2％ （106/192）、40.1％ （77/192）、4.7％ （9/192）的患者属于轻型、中度重型、重症AP;依据DBC分类,分别有57.8％ （111/192）、32.3％（62/192）、7.3％ （14/192）及2.6％ （5/192）的患者属于轻型、中型、重型、极重型AP.各亚组患者愈后差异有统计学意义（P＜0.05）.结论 RAC和DBC分类标准均能准确地反映AP患者的严重程度并能区分各型AP患者愈后.

Objective To validate the accuracy of the revised Atlanta classification （RAC） and the determinant-based classification （DBC） for severity of acute pancreatitis.Methods We retrospectively analysed the clinical data from 192 patients with acute pancreatitis who were admitted to our hospital between January 2014 and October 2014.Using the RAC and the DBC,The duration of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality were assessed in the subgroups,respectively.Results Fluid collections in and around the pancreas was present in 74 patients （38.5％）,pancreatic or peripancreatic necrosis in 51 （26.6％）,and infection in 18 （9.4％）.On the basis of the RAC,106 patients （55.2％）,77 patients （40.1％）,and 9 patients （4.7％） were classified to have mild,moderately severe,or severe AP,respectively.On the basis of the DBC,11l （57.8％）,62 （32.3％）,14 （7.3％）,and 5 （2.6％） patients were classified to have mild,moderate,severe,or critical AP,respectively.The different categories of severity for each classification system were significantly associated with the duration of total parenteral nutrition,the length of ICU and hospital stay,the operation rate and mortality.Conclusion Both the RAC and DBC accurately classified the severity of AP and differentiated prognosis in the subgroups of patients.