De Campos Tercio, Parreira José Gustavo, Assef José Cesar, Rizoli Sandro, Nascimento Barto, Fraga Gustavo Pereira
Santa Casa Sao Paulo, Sao Paulo, SP, Brazil.
Rev Col Bras Cir. 2013 Mar-Apr;40(2):164-8. doi: 10.1590/s0100-69912013000200015.
Based on the Atlanta Classification, acute pancreatitis is classified according to its severity in either mild or severe acute pancreatitis. In recent years, several issues regarding acute pancreatitis have been discussed in the literature. These issues include how many categories of severity should be considered; whether or not a patient with organ failure holds similar holds severity of disease and prognosis of a patient with infected necrosis; the role of transient organ failure; and how to evaluate organ failure. The"Evidence-based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) conducted a review of the recent literature on the topic, and critically appraised its most relevant pieces of evidence.. The articles discussed suggested classifying the severity of acute pancreatitis in three or four categories, rather than mild or severe only, and addressed which is the best score to assess organ failure. The following recommendations were proposed: (1) Acute pancreatitis should be classified into four categories: mild, moderate, severe and critical, which allows a better determination of the characteristics of patients, (2) Evaluation of organ failure with a severity score that preferably evaluate directly each organ failure, such as the SOFA and MODS (Marshall). The SOFA seems to have greater accuracy, but the MODS has better applicability due to its ease of use.
根据亚特兰大分类标准,急性胰腺炎根据其严重程度分为轻度或重度急性胰腺炎。近年来,文献中讨论了几个关于急性胰腺炎的问题。这些问题包括应考虑多少严重程度类别;器官衰竭患者与感染性坏死患者的疾病严重程度和预后是否相似;短暂性器官衰竭的作用;以及如何评估器官衰竭。“循证远程医疗——创伤与急性护理手术”(EBT-TACS)对该主题的近期文献进行了综述,并对其最相关的证据进行了批判性评估。所讨论的文章建议将急性胰腺炎的严重程度分为三类或四类,而不是仅分为轻度或重度,并探讨了评估器官衰竭的最佳评分方法。提出了以下建议:(1)急性胰腺炎应分为四类:轻度、中度、重度和危重症,这有助于更好地确定患者特征;(2)使用严重程度评分评估器官衰竭,该评分最好能直接评估每个器官衰竭,如序贯器官衰竭评估(SOFA)和多器官功能障碍综合征(MODS,马歇尔评分)。SOFA似乎具有更高的准确性,但MODS因其易于使用而具有更好的适用性。