红细胞压积对重症急性胰腺炎早期预测的临床意义

A study on hematocrit as a predictable marker for early severe acute pancreatitis

目的:探讨用红细胞压积(hematocrit,HCT)作为重症急性胰腺炎早期预测指标的可行性。方法:按1996年全国统一诊断标准,将我院普外科2000年1月～2002年4月收治的161例急性胰腺炎病人,分为轻型、重症Ⅰ型及重症Ⅱ型三组;测定各组病人入院当天及入院后第3天的HCT值,并按APACHE Ⅱ评分系统评分。用Kruskal-Wallis检验进行三组HCT值中位数的比较,用Mann-Whitney检验进行三组HCT值的两两比较,用卡方检验进行三组间HCT值增加病人所占比例的比较,并分别将HCT评分与分型、CT严重度等级、重要器官损害数目、腹水量等级及治疗结果进行等级相关分析。结果:三组急性胰腺炎的HCT值及HCT值增加病人所占比例的差异有显著性,HCT评分与治疗结果呈负相关,与分型、CT严重度等级、受损器官数目及腹水量等级是正相关。结论:入院时HCT升高入院后第3天HCT持续不降可作为重症急性胰腺炎的早期预测指标,是提示胰腺病变严重程度及可能发生重要器官功能损害的高危困素。

Objective: To study the feasibility of hematocrit( HCT) as a predictable marker for early severe acute pan-creatitis(SAP) . Methods: According to the diagnostic criterion of 1996,161 patients with acute pancreatitis(AP) in our hospital from January of 2000 to April of 2002 were divided into three groups: mild AP( MAP) , type Ⅰ of SAP and type Ⅱ of SAP. The values of HCT in the first day and in the third day after hospitalization were measured and scored according to APACHE Ⅱ scoring system. The value of HCT and the proportion of the patients with increased value of HCT among the three groups were compared. The rank correlation analysis of score of HCT with the typing, the severity grade of CT, the number of the damaged important organs, the grade of ascites volume and the therapeutic result was carried out. Results: There was statistic signification in the value of HCT and the proportion of the patients with increased value of HCT among the three groups. There was the negative correlation between the score of HCT and the therapeutic result, there was the positive correlation in the score of HCT with the typing,the severity grade of CT, the number of the damaged important organs and the grade of ascites volume. Conclusion: Increased value of HCT in the first day and continued increased value of HCT in the third day may be an early predictable marker of SAP and may be a high-risk factor indicating that pancreatic lesion is severe and may result in damage of important organs.