CAJ | 학술논문

目的探讨改良的早期预警评分(MEWS)在急性胰腺炎轻重和病程评估方面的作用.方法上海交通大学医学院附属仁济医院2006年11月至2007年5月由急诊收入92例急性胰腺炎的患者.急性胰腺炎的诊断采用美国急性胰腺炎临床指南的标准,符合以下三条中的二条:(1)具有急性胰腺炎特征性腹痛;(2)血清淀粉酶≥正常值上限3倍;(3)急性胰腺炎特征性的B超或CT表现.患者本身合并有心肺肝肾功能不全等疾病的排除在外.入院后第1,2,3天记录患者的MEWS评分,观察其分值分布及动态变化.根据MEWS评分分为重危组(MEWS≥4)和一般组(MEWS<4),比较两组患者的病程、器官衰竭发生率和死亡率.对患者入院当天分别行MEWS评分、Rason评分和急性生理与慢性健康评分(APACHEⅡ评分),观察其相关性.统计方法采用相关性分析以及团体t检验.率的比较采用X~2检验.结果 MEWS分值≥4分的患者病程明显长于其他患者,器官衰竭发生率明显增高,且经过处理后分值未能下降的患者死亡率更高.MEWS评分与Rason评分、APACHEⅡ评分呈正相关.结论 MEWS评分可以用来评估急性胰腺炎患者的轻重及预后.MEWS评分简便易行,适合早期筛选危重急性胰腺炎患者.
목적 탐토개량적조기예경평분(MEWS)재급성이선염경중화병정평고방면적작용.방법 상해교통대학의학원부속인제의원2006년11월지2007년5월유급진수입92례급성이선염적환자.급성이선염적진단채용미국급성이선염림상지남적표준,부합이하삼조중적이조:(1)구유급성이선염특정성복통;(2)혈청정분매≥정상치상한3배;(3)급성이선염특정성적B초혹CT표현.환자본신합병유심폐간신공능불전등질병적배제재외.입원후제1,2,3천기록환자적MEWS평분,관찰기분치분포급동태변화.근거MEWS평분분위중위조(MEWS≥4)화일반조(MEWS<4),비교량조환자적병정、기관쇠갈발생솔화사망솔.대환자입원당천분별행MEWS평분、Rason평분화급성생리여만성건강평분(APACHEⅡ평분),관찰기상관성.통계방법채용상관성분석이급단체t검험.솔적비교채용X~2검험.결과 MEWS분치≥4분적환자병정명현장우기타환자,기관쇠갈발생솔명현증고,차경과처리후분치미능하강적환자사망솔경고.MEWS평분여Rason평분、APACHEⅡ평분정정상관.결론 MEWS평분가이용래평고급성이선염환자적경중급예후.MEWS평분간편역행,괄합조기사선위중급성이선염환자.
Objective To evaluate the modified early warning score (MEWS) system in the assessment of the severity and prognosis in acute pancreatitis (AP). Method Ninety two AP patients had been recruited from the Department of Emergency Medicine during November, 2007 to May, 2008. All patients fulfilled at least 2 of the three criteria of American AP clinical guideline, (1) typical abdominal pain; (2) serum amylase level ≥3times of upper normal limit; (3) typical ultrasound or CT findings for AP. Patients with cardiac, pulmonary, hepatic , renal insufficiency or other comorbidities were ruled out. Each patient was evaluated MEWS at day 1,2, and 3 after admission, and subsequently stratified into two groups: high risk group with MEWS ≥4 and moderate risk group with MEWS < 4. The clinical course, end organ failure, and mortality rate was compared between two groups. Other parameters including Ranson score, APACHE Ⅱ score were also obtained. Spearman correlation,group student t test, or Chi square tests were used. Results High risk group has significant prolonged clinical course ( P < 0.05 ) , higher end organ failure rate (P < 0.01) , compared to low risk group. Patients who can not achieve MEWS improvements after interventions have the highest mortality rate (P < 0.01). The MEWS positively correlated with Ranson and APACHE Ⅱ scores ( r = 0.486, and 0.583, respectively, P <0.05). Conclusions MEWS is a valid and simple tool to evaluate severity and prognosis of AP in early stage.