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目的探讨评估重症急性胰腺炎(SAP)的不同方法对SAP预后的判断效果。方法回顾性分析10年间收治168例SAP患者的临床资料。运用受试者工作特征曲线(ROC曲线)下面积,单因素和多因素分析评价序贯器官衰竭评分(SOFA)、急性生理和慢性健康评估(APACHEⅡ)及CT严重性指数(CTSI)对SAP预后结果的预测能力。结果ROC曲线面积比较:SOFA,APACHEII,CTSI的ROC曲线下面积分别为0.846,0.809和0.779;SOFA与CTSI评分比较,差异有统计学意义(Z=2.68,P<0.01);APACHEII与SOFA,CTSI比较,差异无统计学意义(Z=1.079,P>0.05和Z=0.693,P>0.05)。单因素分析显示,住院期最大SOFA计分、最大APACHEⅡ评分、最大CT计分指数、年龄、胰腺感染等与SAP预后相关;多因素分析表明,最大SOFA计分、最大APACHEⅡ评分、最大CT计分指数为SAP预后判别预测的独立相关因素。联合评价表明,三者阳性与二者阳性或一个阳性的SAP患者病死率比较,有统计学意义(P<0.05)。结论动态观测SAP患者住院期间的SOFA,APACHEⅡ和CTSI对SAP预后有较强的判别预测能力,联合三者建立的判别方程具有更佳的SAP预后判别效果。
Objective To evaluate the effect of different methods of evaluating severe acute pancreatitis (SAP) on the prognosis of SAP. Methods A retrospective analysis of clinical data of 168 SAP patients admitted in 10 years. The prognosis of SAP patients was assessed using the area under the receiver operating characteristic curve (ROC curve), univariate and multivariate analyzes of sequential organ failure (SOFA), acute physiology and chronic health assessment (APACHE II) and CT severity index (CTSI) The predictive ability of the results. Results The area under the ROC curves of SOFA, APACHEII and CTSI were 0.846, 0.809 and 0.779, respectively. There was significant difference between SOFA and CTSI (Z = 2.68, P <0.01). APACHEII and SOFA, CTSI The difference was not statistically significant (Z = 1.079, P> 0.05 and Z = 0.693, P> 0.05). Univariate analysis showed that the maximum SOFA score, the maximum APACHE II score, the maximum CT score index, the age and the pancreas infection in the hospitalization period were correlated with the prognosis of SAP. Multivariate analysis showed that the maximum SOFA score, the maximum APACHEⅡ score and the maximum CT score The index is an independent and relevant factor for predicting the prognosis of SAP. The combined evaluation showed that there was a statistically significant difference (P <0.05) in mortality between the three positives and the two positive patients or one positive SAP patient. Conclusions The dynamic observation of SOFA, APACHEⅡ and CTSI in SAP patients during hospitalization has a strong ability of discriminating and predicting SAP prognosis. The discriminant equation established by the combination of the three has better prognostic value of SAP.