Larvin M, McMahon M J
University Department of Surgery, General Infirmary, Leeds.
Lancet. 1989 Jul 22;2(8656):201-5. doi: 10.1016/s0140-6736(89)90381-4.
The value of the Acute Physiology and Chronic Health Enquiry (APACHE-II) score, the Simplified Acute Physiology score, and the Medical Research Council (MRC) sepsis score were compared with clinical assessment and Ranson and Imrie scores in the evaluation and monitoring of acute pancreatitis in 290 attacks. Attacks were graded mild (231) if uncomplicated, or severe (59) when major organ failure or a pancreatic collection occurred. Only APACHE-II scores were available at the time of admission; they correctly predicted outcome in 77% of attacks and identified 63% of severe attacks, compared with 44% achieved by clinical assessment. After 48 h, APACHE-II was most accurate, and correctly predicted outcome in 88% of attacks, compared with 69% for Ranson and 84% for Imrie scores. APACHE-II predicted 73% of pancreatic collections at 48 h, compared with 65% for Ranson and 58% for Imrie scores. In acute pancreatitis, APACHE-II may facilitate rapid selection of patients for intensive therapy or clinical trials, improve comparison between groups of patients, and indicate that a pancreatic collection is probable.
在对290例急性胰腺炎发作的评估和监测中，将急性生理与慢性健康状况评分系统（APACHE-II）评分、简化急性生理学评分以及医学研究委员会（MRC）脓毒症评分与临床评估、兰森评分和伊姆里评分进行了比较。若发作无并发症，则分级为轻度（231例）；若出现主要器官衰竭或胰腺积液，则分级为重度（59例）。入院时仅可获得APACHE-II评分；其在77%的发作中正确预测了结局，识别出63%的重度发作，相比之下，临床评估的正确率为44%。48小时后，APACHE-II最为准确，在88%的发作中正确预测了结局，相比之下，兰森评分的正确率为69%，伊姆里评分为84%。APACHE-II在48小时时预测出73%的胰腺积液，相比之下，兰森评分为65%，伊姆里评分为58%。在急性胰腺炎中，APACHE-II可能有助于快速筛选出适合强化治疗或临床试验的患者，改善患者组间的比较，并提示可能存在胰腺积液。
