CAJ | 학술논문

目的探索建立以检测胆源性病因为重点的实用而有效的急性胰腺炎(AP)病因诊断临床路径.方法 2008年1月至2009年5月四川大学华西医院2216例AP患者被随机分为对照组(1120例)和路径组(1096例).前者病因搜寻方法根据医生的经验和习惯而定,后者按本研究设计的临床路径搜寻病因.结果两组患者基础资料的差异无统计学意义.路径组病因明确率为91.1％(999/1096),显著高于对照组的65.5％(734/1120),P＜0.05.路径组在提高病因明确率方面主要增加了胆管结石、十二指肠疾病和胰腺分裂的检出率,P值均＜0.05.路径组磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP)检查的病因阳性率分别为59.1％( 273/462)及86.0％(98/114).结论本研究设计的AP病因临床诊断路径可显著提高胆源性病因的检出率,具有较好的可操作性,对提高AP诊断质量具有积极意义.
목적 탐색건립이검측담원성병인위중점적실용이유효적급성이선염(AP)병인진단림상로경.방법 2008년1월지2009년5월사천대학화서의원2216례AP환자피수궤분위대조조(1120례)화로경조(1096례).전자병인수심방법근거의생적경험화습관이정,후자안본연구설계적림상로경수심병인.결과 량조환자기출자료적차이무통계학의의.로경조병인명학솔위91.1％(999/1096),현저고우대조조적65.5％(734/1120),P＜0.05.로경조재제고병인명학솔방면주요증가료담관결석、십이지장질병화이선분렬적검출솔,P치균＜0.05.로경조자공진이담관성상(MRCP)급내경역행이담관조영(ERCP)검사적병인양성솔분별위59.1％( 273/462)급86.0％(98/114).결론 본연구설계적AP병인림상진단로경가현저제고담원성병인적검출솔,구유교호적가조작성,대제고AP진단질량구유적겁의의.
Objective To establish a practical and effective clinical pathway (CP) for the etiological diagnosis of acute biliary pancreatitis.Methods A total of 2216 patients enrolled were randomly divided into control group (n =1120) and CP group (n =1096) according to different etiological diagnosis methods including following doctor's established experiences and habits and the designed CP in our study.Results There was no significant difference in baseline data between the two groups.The etiology of acute pancreatitis was determined in 91.1％ (999/1096) of cases in the CP group which was significantly higher than the control group (65.5 ％,734/1120),P ＜ 0.05.The enhanced etiological determination of CP group was mainly consisted of the increased detection of biliary stones,duodenal diseases as well as pancreas divisum,P ＜ 0.05.The positive etiological determination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in the CP group were 59.1％ (273/462) and 86.0％ (98/114),respectively.Conclusions The CP established in this study significantly enhances the biliary etiological determination of acute pancreatitis. It is easy to be conducted and may be of importance to improve the quality of etiological diagnosis of acute pancreatitis.