Liu Terrence H, Kwong Karen L, Tamm Eric P, Gill Brijesh S, Brown Steven D, Mercer David W
Departments of Surgery, The University of Texas-Houston Medical School and Lyndon B. Johnson General Hospital, Houston, TX, USA.
Crit Care Med. 2003 Apr;31(4):1026-30. doi: 10.1097/01.CCM.0000049951.77583.85.
To assess the value of clinical and/or radiographic prognostic indices in predicting the clinical course and outcome of patients with acute pancreatitis, in the intensive care unit.
Retrospective, single institution review.
An adult medical and surgical intensive care unit in a public, urban teaching hospital.
Patients with acute pancreatitis requiring intensive care unit admission between January 1, 1997 and June 30, 2000.
Standard care.
A total of 477 patients were hospitalized with the diagnosis of acute pancreatitis. Of these, 28 patients (6%) were admitted to the intensive care unit. Ranson's, Imrie scores, Acute Physiologic and Chronic Health Evaluation (APACHE) II and III scores, simplified acute physiology scores, and multiple organ dysfunction scores were tabulated at 1, 2, 3, 7, and 14 days after intensive care unit admission. Abdominal computed tomography was available for review for 24 of the 28 patients (86%), where the mean Balthazar's computed tomography index was 4.5 +/- 0.4 (range = 2 to 10). Hospital mortality rate for the intensive care unit patients was 14% (4 of 28). The intensive care unit length of stay ranged from 1 to 79 days (mean 15 days, median 5 days). Fifty-seven percent of the patients developed organ dysfunction, and 36% of the patients required mechanical ventilatory support, ranging in duration from 1 to 70 days. Infectious morbidity occurred in 43% of patients. Thirty-six percent of the patients required operative intervention for intraabdominal complications. APACHE II scores at 7 days after intensive care unit admission correlated closely with ventilator days (r2 =.90; p =.003) and correlated with the occurrence of infectious complications (r2 =.71; p =.02). Patient age, APACHE III, simplified acute physiology scores, multiple organ dysfunction scores, Ranson, Imrie, computed tomography, and APACHE II scores before day 7 did not closely correlate with the occurrence of adverse clinical outcome.
The clinical course and outcomes of intensive care unit patients with acute pancreatitis can be highly variable. An APACHE II score <10 during the initial 48 hrs correlated with mild pancreatitis and uncomplicated intensive care unit course; however, multifactorial prognosticators were not useful for the early identification of patients who developed complications or required extended intensive care unit care.
评估临床和/或影像学预后指标对预测重症监护病房中急性胰腺炎患者的临床病程及结局的价值。
回顾性单机构研究。
一所城市公立教学医院的成人内科及外科重症监护病房。
1997年1月1日至2000年6月30日期间因急性胰腺炎需入住重症监护病房的患者。
标准治疗。
共有477例患者被诊断为急性胰腺炎并住院治疗。其中，28例（6%）入住重症监护病房。在入住重症监护病房后的第1、2、3、7和14天记录兰森评分、伊姆里评分、急性生理与慢性健康状况评估（APACHE）II和III评分、简化急性生理学评分及多器官功能障碍评分。28例患者中有24例（86%）可进行腹部计算机断层扫描复查，其巴尔萨泽计算机断层扫描指数平均为4.5±0.4（范围为2至10）。重症监护病房患者的医院死亡率为14%（28例中的4例）。重症监护病房住院时间为1至79天（平均15天，中位数5天）。57%的患者出现器官功能障碍，36%的患者需要机械通气支持，持续时间为1至70天。43%的患者发生感染性并发症。36%的患者因腹腔内并发症需要手术干预。入住重症监护病房7天后的APACHE II评分与机械通气天数密切相关（r2 = 0.90；p = 0.003），并与感染性并发症的发生相关（r2 = 0.71；p = 0.02）。患者年龄、APACHE III、简化急性生理学评分、多器官功能障碍评分、兰森评分、伊姆里评分、计算机断层扫描及入住第7天前的APACHE II评分与不良临床结局的发生无密切相关性。
重症监护病房中急性胰腺炎患者的临床病程及结局差异很大。最初48小时内APACHE II评分<10与轻度胰腺炎及重症监护病房无并发症病程相关；然而，多因素预后指标对早期识别发生并发症或需要延长重症监护病房治疗时间的患者并无帮助。
