摘要
目的分析急性胰腺炎（ＡＰ）的预后因素．方法ＡＰ患者１７８例，男７６例，女１０２例，年龄１７岁～８５岁，平均５３６岁±１６岁，其中水肿型１２０例，坏死型５８例．分别以Ｒａｎｓｏｎ标准和ＢａｎｋＷｉｓｅ标准作为判断轻症和重症的标准．ＣＴ和（或）Ｂ超对ＡＰ的诊断采用Ｂａｌｔｈａｚａｒ分级法．结果Ｒａｎｓｏｎ标准５项以下者（轻症）１４９例，死亡率为６０４％，６项以上者（重症）２９例，死亡率为６５５０％．ＢａｎｋＷｉｓｅ标准阴性者（轻症）１４４例，死亡率为４１７％．１项以上阳性者（重症）３４例，死亡率为６４７０％．预测轻症和重症的死亡率这两种标准间差异无显著性（Ｐ＞００５）．年龄、胰腺坏死程度、并发症等对ＡＰ预后有显著的影响（Ｐ＜００１）．ＣＴ和（或）Ｂ超诊断急性坏死型胰腺炎（ＡＮＰ）的敏感度为７０７％，特异度为１００％．结论Ｒａｎｓｏｎ标准应结合ＢａｎｋＷｉｓｅ标准，综合考虑胰腺坏死程度，并发症等对ＡＰ预后的影响．ＣＴ、Ｂ超等影象学诊断对于判断胰腺坏死程度有一定的参考价值．
IM To analyse the prognostic factors of acute pancreatitis (AP). METHODS From January 1985 to June 1996, 178 (male 76, female 102, age 17-85 years) patients with AP were analysed, including edematous type 120 and necrotizing type (ANP) 58. The severity of AP was determined by Ranson′s criteria and BankWise criteria respectively. CT or/and ultrasound for the diagnosis of AP were graded by Balthazar criteria. RESULTS The mortalities of patients with less than 5 factors according to Ranson′s criteria (mild type) and more than 6 factors (severe type) were 604% (9/149) and 6550% (19/29), respectively. The mortalities of patients with BankWise criteria negative (mild type) and one or more factors positive (severe type) were 417% (6/144) and 6470%(22/34). There was no significant difference between this two criteria for the prognostic value of AP (P>005). Age, degree of necrosis and complications influence significantly the prognosis of AP (P<001). The sensitivity and specificity of CT and/or ultrasound for the diagnosis of ANP were 707% and 1000% respectively. CONCLUSION In addition to Ranson′s criteria, BankWise criteria, degree of pancreatic necrosis and complications are also important for the evaluation of prognosis of AP. CT and ultrasound are of some value in judging the degrees of pancreatic necrosis.
关键词
胰腺炎
急性
预后
ancreatitis/diagnosis
acute disease
prognosis
