阑尾炎炎症反应评分在阑尾炎急诊早期诊断中的应用  

Risk stratification by appendicitis inflammatory response scores to guide decisionmaking in patients with suspected appendicitis

作　　者：冯小鹏[1] 叶自力[1] 张雅斯 

机构地区：[1]惠州市第一人民医院急诊内科,广东惠州516003

出　　处：《中国校医》2017年第3期215-216,218,共3页Chinese Journal of School Doctor

摘　　要：目的评估阑尾炎炎症反应(Appendicitis Inflammatory Response,AIR)评分在急性阑尾炎急诊的诊断和预测中的意义。方法收集惠州市第一人民医院急诊内科2013年1月至2015年2月82例经术后病理确诊急性阑尾炎的患者的临床资料,所有患者进行AIR评分。结果阑尾炎炎症反应评分低危的患者60例(42.3%),患有阑尾炎为7例。低危病人占就诊总人数的47.6%,其中进行开腹探查的44例患者中有21例显示为阴性探查(47.8%)。对诊断严重阑尾炎或进展性阑尾炎(出现坏疽或穿孔的阑尾炎)的敏感性高的为阑尾炎炎症反应评分≥5,分别为91%,97%。对诊断阑尾炎的特异性高的是阑尾炎炎症反应评分≥9的(高危)的患者为97%,出现穿孔或坏疽的大部分是高危组病人(21/29)。结论 AIR可以减少紧急入院率、降低阴性探查率。C-反应蛋白(C-reactive protein CR P)和中性粒细胞百分比与急性阑尾炎的发展阶段有关。Objective To evaluate the appendicitis inflammatory response（AIR） scores as a tool for the diagnosis and prediction of severity of acute appendicitis. Methods The clinical data of all patients undergoing surgical appendectomy were collected and evaluated by the AIR scores in the Emergency Department of the First People＇s Hospital of Huizhou City from January 2003 to February 2015. Results A total of 142 patients were included, of whom 60（42.3%）with non-appendicitis pain were correctly classified as low risk. However, 7 low-risk patients had appendicitis. The low-risk patients accounted for 47.6% admissions（68/142）, with 47.8% of the negative explorations（21/44）. An AIR score of 5 or more（intermediate and high risk） had high sensitivity for all severities of appendicitis（91%） and also for advanced appendicitis（97%）. An AIR score of 9 or more（high risk） was very specific（97%） for appendicitis, and the majority of patients with appendicitis in the high-risk group（21/29） had perforation or gangrene. Conclusion The risk stratification of patients with suspected appendicitis by the AIR score can guide decision-making to reduce admissions and prevent negative explorations. The serum C-reactive protein and assessment of the percentage of the polymorphonuclear leukocytes count are important to the diagnosis and disease stratification.

关 键 词：阑尾炎/诊断 疾病严重程度指数 决策支持技术 危险性评估 

分 类 号：R656.8[医药卫生—外科学]