腹腔内压测定对危重型急性胰腺炎预后的判断价值  

Prognostic value of intra-abdominal pressure measurement on critical acute pancreatitis

作　　者：柯路[1] 周晶[1] 邹磊[1] 李刚[1] 叶向红[1] 童智慧[1] 李维勤[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科,南京210002

出　　处：《中华胰腺病杂志》2014年第5期289-292,共4页Chinese Journal of Pancreatology

基　　金：国家自然科学基金青年项目（81300360）

摘　　要：目的 分析危重型急性胰腺炎（CAP）的临床特点,探讨腹腔压力（IAP）、APACHEⅡ评分对CAP患者预后预测的价值.方法 筛选2010年1月至2013年3月发病96 h内入住南京军区南京总医院普外科ICU的18～75岁AP患者,其中47例符合根据决定因素的AP分类（determinant-based classification,DBC）中的CAP诊断标准.对这些患者在入院24 h内行APACHEⅡ评分,并测量IAP.记录器官功能衰竭发生情况、中转手术引流例数、入住ICU时间、总住院时间.应用受试者工作特征曲线下面积（AUC）分析IAP、APACHEⅡ评分预测患者预后和中转手术的价值,及其与入住ICU时间、总住院时间的相关性.结果 47例患者入院24h的平均APACHEⅡ评分为13分,平均IAP为16.9 mmHg（1mmHg =0.133 kPa）,血培养阳性22例.发生呼吸系统衰竭45例次（96％）,肾功能衰竭34例次（72％）,心血管功能衰竭22例次（47％）,其中出现2、3个器官系统功能衰竭的患者分别为16、19例.17例（36％）患者接受手术引流.院内病死18例（38％）.平均入住ICU 31 d,平均总住院时间38 d.IAP水平和APACHEⅡ评分随衰竭器官系统数量的增加逐渐升高,差异具有统计学意义（P＜0.001）.IAP水平预测患者病死的AUC为0.80（95％ CI 0.41 ～0.76）,以16.1 mmHg为阈值,其敏感性、特异性分别为83％和62％;APACHEⅡ评分预测的AUC为0.58（95％ CI0.38～0.73）,以13.5分为阈值,其敏感性、特异性分别为44％和73％.IAP水平预测患者病死的敏感性高于APACHEⅡ评分,两者预测中转手术的敏感性均较低,与患者入住ICU时间、总住院时间均无相关性.结论 CAP具有极高的手术率和病死率.早期监测IAP可以有效预测预后较差的CAP患者.Objective To describe the clinical characteristics of critical acute pancreatitis （CAP） and the predictive value of intra abdominal pressure and APACHE Ⅱ score in this group of patients.Methods From January 2010 to March 2013,acute pancreatitis patients between 18 to 75 years old present to the SICU,Department of General Surgery,General Hospital of Nanjing Military Area Command within 96 hours of symptoms onset were screened and forty-seven patients who met the diagnostic criteria of critical acute pancreatitis according to the determinant-based classifications were included in this study.The APACHE Ⅱ score was calculated within 24 h of admission,intra abdominal pressure was measured.Moreover,occurrence of organ dysfunction,need of surgical intervention,length of ICU and hospital stay was also recorded.Receiver operating characteristic curve was used to evaluate predictive accuracy of intra abdominal pressure and APACHE Ⅱ score for mortality and need of surgery.In addition,the correlation between intra abdominal pressure,APACHE Ⅱ score and length of hospital and ICU stay were also analyzed.Results Among the 47 study patients,the median APACHE Ⅱ score and intra abdominal pressure were 13 and 16.9 mmHg,respectively.Positive blood culture was detected in 22 patients.Respiratory dysfunction occurred in 45 cases （96％）,while renal dysfunction occurred in 34 patients （72％） and cardiovascular dysfunction in 22 （47％）.Double organ dysfunction and triple organ dysfunction happened in 16 and 19 patients,respectively.Seventeen （36％） patients needed surgical intervention.The mortality of critical acute pancreatitis patients was as high as 38％ （18/47）.The median length of ICU and hospital stay was 31 and 38 days,respectively.Both APACHE n score and intra abdominal pressure increased significantly as the number of organ dysfunction increased,the difference was statistically significant （P ＜0.001）.For the prediction of mortality,intra abdominal pressure performed better than APACH

关 键 词：危重型急性胰腺炎 腹腔压力 APACHEⅡ评分 预后 判断 

分 类 号：R576[医药卫生—消化系统]