两种评分方法在重症急性胰腺炎患者治疗中的应用  

Application of dynamic APACHE Ⅱ score and POSSUM score in patients with severe acute pancreatitis

作　　者：朱伟东[1] 高伟烨[1] 郑满跃[1] 钟耀区[2] 黄超群[3] 

机构地区：[1]惠州市人民医院普外科,广东省惠州516002 [2]惠州市人民医院重症监护室,广东省516002 [3]惠州市人民医院检验科,广东省惠州516002

出　　处：《中国基层医药》2009年第2期225-226,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨动态急性生理学及慢性病健康状况评分Ⅱ（APACHEⅡ）、生理学及手术严重性评分（POSSUM）在重症急性胰腺炎（SAP）治疗中的应用价值。方法60例SAP患者分为手术组（15例）和非手术组45例，非手术组进行APACHEⅡ评分，对手术组进行POSSUM评分，根据评分情况决定继续保守治疗或手术治疗；观察两种方法与并发症和死亡的关系。结果单次手术组15例，经POSSUM评估并发症发生概率及手术死亡概率分别为（0．37±0．08）及（0．27±0．09）高于多次手术组（11例）的（0．76±0．14）及（0．61±0．15）（t1=3．125，t2=3．211，P〈0．01）；手术组死亡率的APACHEⅡ评分与非手术组元显著性差异（Χ^2=2．28，Χ^2=1．98，P〉0．05）；存活组46例，APACHEⅡ评分（10．12±6．27），低于死亡组14例的（25．75±7．90）（t=2．525，P〈0．05）。结论动态APACHEⅡ评分能较好判断手术时机，POSSUM评分能较好地预测术后并发症及死亡发生情况。Objective To discuss the value of combining the physiological and operative severity score for enumeration of mortality and morbidity （POSSUM） and acute physiology and chronic health evaluation Ⅱ （ APACHEⅡ） in severe acute pancreatitis （SAP）. Methods 60 cases of SAP were divided into surgery group （n = 15 ） and non-surgical group（ n =45） ,Non-surgical group was valude with APACHE Ⅱ score,the surgery group with POSSUM score, decided to continue conservative treatment or surgery treatment, Observation of two ways with the complications and death. Results The rates of complications and death were（0.37±0. 08） and（0. 27 ±0. 09） in Single-operation group（n = 15） higher than（0.76 ±0. 14） and（0. 61 ±0. 15 ） in surgical group（n =11）（t1 =3. 125,t2 =3.211,P 〈0. 01 ） ;APACHE Ⅱ score of mortality in operation group and non-surgical group were no significant difference（Χ^2 = 2. 28,Χ^2 = 1.98, P 〉 0. 05） ; APACHE Ⅱ score were （ 10. 12 ±6. 27 ） in survival group （ n = 46） were lower than （25.75± 7.90） in death group （ n = 14） （ t = 2. 525, P 〈 0. 05. Conclusion The score of dynamic APACHE Ⅱhas better effect to judge the timing of surgery, and the score of POSSUM has high value to predict post-operative complications and deaths occurred in patients with severe acute pancreatitis.

关 键 词：胰腺炎 急性坏死性 生理学及慢性病健康状况评分Ⅱ 生理学和手术严重性评分 

分 类 号：R57[医药卫生—消化系统]