急性胰腺炎严重程度床边指数评分对重症急性胰腺炎预后评估的价值

摘要

目的：探讨急性胰腺炎严重程度床边指数（bedside index for severity in acute pancreatitis，BisaP）评分在重症急性胰腺炎（severe acute pancreatitis,saP）预后评估中的应用价值。方法收集2007年1月至2013年12月我院收治的saP患者143例，记录入院24小时内的血尿素氮、受损的精神状态、全身炎症反应综合征、年龄、胸腔积液5个指标，进行BisaP评分，分析BisaP评分对saP患者多器官功能衰竭及死亡的预测价值。结果143例saP患者中，BisaP评分1分的29例（20.3%），2分的41例（28.7%），3分的46例（32.2%），4分的19例（13.3%），5分的8例（5.6%）。发生多器官功能衰竭者27例（18.9%），用roc曲线评估mof的曲线下面积（auc）为0.840（95%ci：0.745～0.935），最佳阈值为3分。死亡20例，病死率14.0%，用roc曲线评估saP患者死亡的auc值为0.938（95%ci：0.890～0.986），最佳阈值为3分。不同评分之间的多器官功能衰竭发生率、病死率差异均具有统计学意义（P<0.05）。结论BisaP评分是一种简便易行的评分方法，对saP患者的多器官功能衰竭发生及死亡的预测具有较高价值，是评估saP预后的有效指标。%ObjectiveTo evaluate the value of beside index for severity in acute pancreatitis (BisaP) score in predicting the prognosis of severe acute pancreatitis (saP).Method The data from 143 patients with severe acute pancreatitis admitted into our hospital from January,2007 to december,2013 were collected.The BisaP scores were calculated using the data of first 24 hours from admission. BisaP scoring system including five indexes:blood urea nitrogen, impaired mental status, systemic inflammatory response syndrome (sirs), age, and pleural effusion was used to evaluate the predictive value of BisaP scoring system on multiple organ failure (mof) and death in patients with severe acute pancreatitis.Result among those 143 patients, 29 patients were scored 1(20.3%); 41 patients were scored 2(28.7%);46 patients were scored 3(32.2%);19 patients were scored 4(13.3%),and 8 patients were scored 5(5.6%).Twenty-seven patients were diagnosed with multiple organ failure (18.9%).The area under roc curve (auc) for mof was 0.840 (95%ci:0.745~0.935) and the best cutoff point was 3.Twenty patients died and the mortality rate was 14.0%. The area under roc curve (auc) for death was 0.938(95% ci,0.890~0.986)and the best cutoff point was 3. The incidence rate of mof and its mortality rate were significantly different among different BisaP scores (P <0.05).Conclusion BisaP is a simple and feasible scoring system to predict the incidence of mof and death in patients with saP, and it is effective to evaluate the prognosis of severe acute pancreatitis.