Mann D V, Hershman M J, Hittinger R, Glazer G
Department of Surgery, St Mary's Hospital, London, UK.
Br J Surg. 1994 Jun;81(6):890-3. doi: 10.1002/bjs.1800810632.
A prospective audit of acute pancreatitis involving nine hospitals in the North-West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty-nine patients (68 per cent) died after the first week from complications related to infection (26 patients) co-morbid conditions (nine) or non-infective complications (four). Twenty-one patients (42 per cent) had been inadequately evaluated by Ranson's criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection-related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.
对泰晤士河西北地区9家医院的急性胰腺炎进行的一项前瞻性审计在54个月内招募了631名患者。其中57人死亡（9%）；50名患者（88%）在死亡前得到诊断，7名患者（12%）在尸检时得到诊断。18名患者（32%）在第一周内死亡，通常是由于多系统器官衰竭（15名患者）。39名患者（68%）在第一周后死于与感染相关的并发症（26名患者）、合并症（9名）或非感染性并发症（4名）。21名患者（42%）未通过兰森标准进行充分评估，在50名生前诊断为胰腺炎的患者中，只有22名（44%）接受了计算机断层扫描（CT）。26名死于感染相关并发症的患者中有15名进行了CT检查，只有9名接受了坏死组织清除术或手术引流。这些数据表明，改善急性胰腺炎患者的诊断、检查和管理是可行的，并且可能改善临床结果。
