动态APACHEⅢ评分对老年急性胆管炎外科治疗的价值

Surgical treatment of elder acute cholangitis guided by dynamk APACHE Ⅲ scoring

目的:探讨急性生理、年龄及慢性健康评价系统(APACHE Ⅲ)在老年急性胆管炎外科治疗的应用和价值。方法:回顾分析1991～1996年资料齐全的98例患者,按Knaus法计算98例患者APACHE Ⅲ评分及病死率,并进行相关对比分析,所得结论指导1997～2001年69例患者的外科治疗。结果:APACHE Ⅲ评分值越高,病情越重,病死率越高,动态观察APACHE Ⅲ评分意义更大。50分以下,均非手术治疗获得成功;51～90分需急诊手术;91分以上宜先行PTCD、ENBD、或加EST取石术,如插管失败或引流效果欠佳,宜于急诊手术;引流效果好,需结合B超或CT所见决定手术时间。其一对胆管结石或胆道蛔虫伴胆道感染,宜引流48h后待APACHE Ⅲ评分下降至90分以下时予手术治疗;其二对恶性胆道梗阻、多次胆道手术史或伴严重内科合并病患者,宜引流3w后手术。结论:APACHE Ⅲ是一种合理、有效的病情评估系统,可指导老年急性胆管炎的外科治疗;据APACHE Ⅲ动态评分采取相应治疗方法,可提高治愈率。

Objective:To investigate the applied method and the value of APACHE Ⅲ scoring in the treatment of elder acute cholangitis. Methods: The clinical data of 98 patients from 1991 to 1996 were prospectively collected and calculated by Knaus methods, to calculate the mortality ratios and comparative analysis was performed. The valuable conclusion was attained and guided the surgical treatment of 69 patients from 1997 to 2001. Results: The APACHE Ⅲ Scoring is well associated with the prognosis of the critical patient: the higher the APACHE Ⅲ scoring, the higher the motality, and dynamic A-PACHE Ⅲ scoring have more value. According to different score( < 50,51 - 90, > 90) and assisted examination(B-us or CT) ,to adopt different treatment:non-operated, acute operated,and select time operated after draining. Conclusion:The A-PACHE Ⅲ score is a reasonable and effective prediction system, and it can guide the surgical treatment of elder acute cholangitis.