Lakhey Paleswan Joshi, Bhandari Ramesh Singh, Kafle Brindeshwori, Singh Keshaw Prasad, Khakurel Mahesh
Department of Surgery, TUTH, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2013 Oct-Dec;52(192):580-5.
Severe acute pancreatitis, according to Atlanta classification, is a heterogeneous group of patients with different outcomes. The patients with local complications and without organ failure have better outcome. This study has been conducted to determine the proportion of moderately severe acute pancreatitis and validate this subgroup in our population of patients.
A total of 172 patients with the diagnosis of acute pancreatitis were categorized into three groups according to presence or absence of local complications and organ failure as mild acute pancreatitis, moderately severe acute pancreatitis and severe acute pancreatitis and were compared in terms of need for intensive care unit care, length of ICU stay, need for intervention, length of hospital stay and mortality.
Fifty seven (33%) were categorized as moderately severe acute pancreatitis. Need for ICU care (19.3% vs 100%, p<0.001), length of ICU stay (1 vs 9.8 days, p<0.001), length of hospital stay (8.3±3.7 vs 16.6±8.1 days, p<0.001) and mortality (0% vs 33.3%, p<0.001) between moderately severe acute pancreatitis and severe acute pancreatitis was significantly different. Moreover, mild acute pancreatitis and moderately severe acute pancreatitis had no mortality.
This study showed that moderately severe acute pancreatitis exists as a separate group different from mild acute pancreatitis and severe acute pancreatitis with no mortality as in mild acute pancreatitis.
根据亚特兰大分类标准,重症急性胰腺炎是一组具有不同预后的异质性患者群体。伴有局部并发症且无器官功能衰竭的患者预后较好。本研究旨在确定中度重症急性胰腺炎的比例,并在我们的患者群体中验证这一亚组。
总共172例诊断为急性胰腺炎的患者,根据是否存在局部并发症和器官功能衰竭分为三组,即轻度急性胰腺炎、中度重症急性胰腺炎和重症急性胰腺炎,并在重症监护病房护理需求、重症监护病房住院时间、干预需求、住院时间和死亡率方面进行比较。
57例(33%)被归类为中度重症急性胰腺炎。中度重症急性胰腺炎和重症急性胰腺炎在重症监护病房护理需求(19.3%对100%,p<0.001)、重症监护病房住院时间(1天对9.8天,p<0.001)、住院时间(8.3±3.7天对16.6±8.1天,p<0.001)和死亡率(0%对33.3%,p<0.001)方面存在显著差异。此外,轻度急性胰腺炎和中度重症急性胰腺炎均无死亡病例。
本研究表明,中度重症急性胰腺炎作为一个独立的组存在,不同于轻度急性胰腺炎和重症急性胰腺炎,且与轻度急性胰腺炎一样无死亡率。