重症急性胰腺炎新亚特兰大分类再评价的临床研究  

A clinical study of classifying the traditional severe acute pancreatitis based on the latest Atlanta classification

作　　者：丁晴宇 程天明[1,2] 许乙凯[3] 陈嘉莹[1] 吕杨[1] 蔡建群[1] 

机构地区：[1]南方医科大学南方医院消化科(广东省胃肠疾病重点实验室),广州510515 [2]南方医科大学南方医院惠侨科,广州510515 [3]南方医科大学南方医院影像中心,广州510515

出　　处：《安徽医科大学学报》2016年第9期1346-1349,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金面上项目(编号:81271642)

摘　　要：目的分析新亚特兰大分类下重症急性胰腺炎患者(SAP)和中度重症急性胰腺炎患者(MSAP)的临床特点,探讨将持续性器官功能衰竭的数目作为分类标准的临床价值。方法收集207例传统SAP患者的临床资料,按照新亚特兰大分类标准将其重新分类为MSAP和SAP两组。根据持续性(>48 h)器官衰竭的数目,将新分类下的SAP进一步分成SOF及MOF亚组。分析各组间的临床治疗过程、评分以及预后。结果 207例传统SAP患者包括131例MSAP及76例SAP,SAP组包括SOF亚组52例及MOF亚组24例。新分类下SAP组患者在重症监护病房需要率、透析、气管插管、输血、血管活性药物使用率、评分以及院内死亡率方面均高于MSAP组(P<0.01)。MOF亚组的上述指标亦高于SOF亚组(P<0.05)。结论新亚特兰大分类更准确地反映病情严重程度,同时建议在临床上将持续性器官衰竭的数目纳入分类标准,以在疾病早期及时识别危重患者。Objective To analyze the difference in clinical characteristics and prognosis between patients with severe accurate pancreatitis（ SAP） and moderatelysevere acute pancreatitis（ MSAP） confirmed using the latest Atlanta classification. To further classify SAP based on the number of persistent（〉 48 h） organ failure（ OF） and assess its clinical value. Methods 207 traditional SAP patients were re-classified as SAP or MSAP based on the latest Atlanta classification. According to the number of persistent OF,SAP was further stratified into MOF and SOF subgroup.The demographic,clinical characteristics and prognosis were compared among these groups. Results Among the207 included patients,131 were classified as MSAP and 76 as SAP. In SAP group,24 cases were classified in MOF subgroup. Compared with the MSAP patients,the SAP patients demonstrated higher mortality,higher intensive care unit（ ICU） admission rates,and higher scores（ P 〈0. 01）. Except for the MCTSI score,these outcomes were higher in the MOF subgroup than that of the SOF subgroup（ P〈 0. 05）. Conclusion The latest Atlanta classification accurately reflect the patients＇ clinical outcomes. The number of persistent OF and the scoring system results can help to identify critical patients in the early stage of the disease.

关 键 词：重症急性胰腺炎 新亚特兰大分类 持续性器官衰竭 预后评分 

分 类 号：R576[医药卫生—消化系统]