目的:分析重症超声与CT评分联合急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHE Ⅱ)对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的评估价值.方法:回顾分析2020年1月-2024年1月同济大学附属第十人民医院综合1CU收治的180例SAP患者临床资料,对所有患者进行重症超声、CT检查及APACHE Ⅱ评分评估,按照患者临床预后的不同分为好转组(126例)和加重组(54例),比较两组患者一般临床资料、超声评分、CT评分及APACHE Ⅱ评分,分析SAP预后的影响因素.采用受试者工作特征(receiver operating characteristic curve,ROC)曲线预测3种检测手段对SAP患者预后评估的价值.结果:两组患者年龄、入院前腹痛时间、病因、性别等一般临床资料比较,差异无统计学意义(P＞0.05);但加重组患者的超声评分、CT评分及APACHE Ⅱ评分分别为(9.12±2.46)分、(3.18±0.84)分、(47.59±11.16)分,显著高于好转组的(5.88±1.23)分、(2.22±0.66)分、(40.61±10.21)分,两组比较差异有统计学意义(P＜0.05).logistic回归分析显示,重症超声评分、CT评分与APACHE Ⅱ评分均是SAP预后情况的影响因素(P＜0.05).ROC曲线结果显示,重症超声、CT评分、APACHE Ⅱ评分三者联合检测的诊断效能最大:灵敏度为88.89％,特异度为92.86％,AUC为0.909.结论:重症超声、CT评分及APACHE Ⅱ评分可影响SAP预后,对SAP患者的预后具有一定的预估价值,3种检测方式联合预测对SAP患者诊治具有临床指导价值,值得临床重视.
Prognostic value of critical ultrasound score and CT score combined with APACHE Ⅱ score in patients with severe acute pancreatitis
Objective:To analyze the prognostic value of critical ultrasound score and CT score combined with the acute physiology and chronic health evaluation(APACHE)Ⅱ score in patients with severe acute pancreatitis(SAP).Methods:The clinical data of 180 patients with SAP who were admitted to comprehensive ICU of the hos-pital from January 2020 to January 2024 were analyzed retrospectively.All patients underwent critical ultrasound examination,CT examination and APACHE H evaluation.They were divided into the improvement group(n=126)and the exacerbation group(n=54)according to the prognosis.General clinical data,ultrasound scores,CT scores and APACHE H scores of the two groups were comparatively analyzed.The factors influencing the prog-nosis of SAP were analyzed.The receiver operating characteristic(ROC)curves were used to evaluate the prog-nostic value of the three methods in patients with SAP.Results:There was no statistically significant difference in general clinical data such as age,duration of abdominal pain before admission,cause of disease and gender between the two groups(P＞0.05).Ultrasound score,CT score and APACHE Ⅱ score of the exacerbation group([9.12±2.46],[3.18±0.84],[47.59±11.16])were significantly higher than those of the improvement group([5.88±1.23],[2.22±0.66],[40.61±10.21])(P＜0.05).logistic regression analysis showed that critical ul-trasound score,CT score and APACHE Ⅱ score were factors influencing the prognosis of SAP(P＜0.05).ROC curve analysis results showed that the prognostic efficacy of the combination of critical ultrasound score,CT score and APACHE Ⅱ score was the highest.The sensitivity,specificity and AUC were 88.89％,92.86％and 0.909,respectively.Conclusion:Critical ultrasound score,CT score and APACHE Ⅱ score influence the prognosis of SAP,and they have certain value in predicting the prognosis of SAP.Joint prediction with the three above is of guiding value in the diagnosis and treatment of patients with SAP,which deserves attention in clinic.
critical ultrasonographyCT scoreacute physiology and chronic health evaluationsevere acute pancreatitisprognosis evaluation
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