LUS、APACHEⅡ及BISAP评分对重症急性胰腺炎预后的评估作用  

The effect of LUS,APACHEⅡand BISAP score on the prognosis of severe acute pancreatitis

作　　者：杨立寰 尚德民 王昊峰 魏蓝海 Yang Lihuan;Shang Demin;Wang Haofeng;Wei Lanhai(Department of Intensive Care Medicine,Zhangye People′s Hospital Affiliated to Hexi University,Zhangye 734000,China)

机构地区：[1]河西学院附属张掖人民医院重症医学科,甘肃张掖734000 [2]河西学院附属张掖人民医院超声科,甘肃张掖734000

出　　处：《中国急救医学》2025年第2期117-121,共5页Chinese Journal of Critical Care Medicine

基　　金：2024年高校教师创新基金项目(2024B-161)。

摘　　要：目的研究肺部超声评分(LUS)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分和急性胰腺炎严重程度床边指数(BISAP)对重症急性胰腺炎(SAP)预后的评估作用。方法选择2021年1月至2023年6月河西学院附属张掖人民医院重症医学科收治的186例SAP患者,根据入院后28 d的生存情况分为存活组(n=132)和死亡组(n=54)。入院后24 h内完成BISAP、APACHEⅡ、全身炎症反应综合征(SIRS)评分、实验室指标、床旁肺部超声及LUS,入院后48 h内完成Ranson评分和格拉斯哥昏迷评分(GCS)。比较两组患者各项评分及实验室指标的差异,采用Logistic回归分析SAP患者28 d死亡的影响因素,采用受试者工作特征(ROC)曲线分析各指标对SAP患者28 d死亡的预测价值。结果死亡组LUS、APACHEⅡ、BISAP评分及血清C反应蛋白、降钙素原均高于存活组(P均<0.05),两组间SIRS、Ranson、GCS评分及其他一般资料、实验室指标比较差异无统计学意义(P>0.05);LUS、BISAP和APACHEⅡ评分增加是SAP患者28 d死亡的危险因素(P<0.05);LUS、BISAP和APACHEⅡ评分预测SAP患者28 d死亡的曲线下面积(AUC)分别为0.842、0.758和0.682,将Logistic回归分析方程作为LUS、BISAP和APACHEⅡ评分联合预测SAP患者28 d死亡的新指标,联合预测的AUC为0.933,高于单一指标的AUC(Z=4.571、P=0.022,Z=5.831、P=0.012,Z=6.523、P=0.005)。结论LUS、BISAP和APACHEⅡ评分三项联合对SAP预后具有良好的评估价值。Objective To evaluate the effect of lung ultrasound score(LUS)combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ)and bedside index for severity in acute pancreatitis(BISAP)on the prognosis of severe acute pancreatitis(SAP).Methods A total of 186 SAP patients admitted to Department of Intensive Care Medicine,Zhangye People′s Hospital Affiliated to Hexi University from January 2021 to June 2023 were selected.According to the survival conditions 28 days after admission,the survivors were selected as the control group(n=132)and the dead patients were selected as the death group(n=54).BISAP,APACHEⅡ,systemic inflammatory response syndrome(SIRS)scores,laboratory indicators,bedside lung ultrasound and LUS were completed within 24 hours after admission.Ranson score and Glasgow coma score were completed within 48 hours after admission.The differences in various scores and laboratory indicators were compared between two groups,Logistic regression was used to analyze the influencing factors of 28-day death in SAP patients,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each indicator for 28-day death in SAP patients.Results The LUS,APACHEⅡand BISAP score,serum C-reactive protein and procalcitonin in the death group were higher than those in the control group(P<0.05).There were no significant differences in SIRS,Ranson and GCS scores,other general data and laboratory indexes between the two groups(P>0.05).The increase of LUS score,BISAP score and APACHEⅡscore was the risk factor for 28-day death in SAP patients(P<0.05).The area under curve(AUC)of LUS score,BISAP score and APACHEⅡscore in predicting 28-day death of SAP patients was 0.842,0.758 and 0.682,respectively.Logistic regression analysis equation was used as a new index for the combined prediction of LUS score,BISAP score and APACHEⅡscore for 28-day death of SAP patients,and the AUC of combined prediction was 0.933,which was higher than a single indicator(Z=4.571,P=0.022,Z=5.831,P=0.012,Z=6.

关 键 词：重症急性胰腺炎 预后 肺部超声评分 急性生理学和慢性健康状况评价Ⅱ 急性胰腺炎严重程度床边指数 

分 类 号：R57[医药卫生—消化系统]