本文選題：急性胰腺炎　切入點(diǎn)：亞特蘭大分類　出處：《第二軍醫(yī)大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：前言：急性胰腺炎是一種臨床過程及結(jié)果比較多變的疾病，約20%的急性胰腺炎患者臨床經(jīng)過嚴(yán)重。而且重癥急性胰腺炎患者病死率達(dá)到10-30%。目前，在美國，每年有超過22萬的急性胰腺炎患者被收住入院，且急性胰腺炎已居胃腸疾病相關(guān)住院的首位。而且發(fā)病率也在不斷增長，尤其是重癥急性胰腺炎。盡管急性胰腺炎在治療上有了很大的進(jìn)展，但病死率仍然較高。然而，有研究者認(rèn)為特異有效的治療方法至少部分依賴于精確的分類。急性胰腺炎嚴(yán)重程度的精確分類對于臨床工作及研究都是很重要的。在臨床工作中，精準(zhǔn)的分類對于確定疾病嚴(yán)重程度，密切關(guān)注疾病臨床過程及臨床決策都是很有價(jià)值的。在臨床研究中，對于納入臨床試驗(yàn)研究對象的準(zhǔn)確性具有重大意義。急性胰腺炎按照傳統(tǒng)的1992年Atlanta嚴(yán)重程度分類分成輕癥急性胰腺炎及重癥急性胰腺炎。2012年分類學(xué)家對Atlanta嚴(yán)重程度分類進(jìn)行了修正，分為3類：輕癥急性胰腺炎，，中度急性胰腺炎和重癥急性胰腺炎。 研究目的：本研究的目的就是應(yīng)用上述兩種亞特蘭大分類系統(tǒng)進(jìn)行回顧性研究。對急性胰腺炎的1992年亞特蘭大分類和2012年亞特蘭大分類的臨床結(jié)果進(jìn)行比較，進(jìn)一步評價(jià)這兩種分類系統(tǒng)。因輕癥急性胰腺炎分類標(biāo)準(zhǔn)未發(fā)生改變，故本研究只對重癥急性胰腺炎做比較。另外，我們還建議將胰腺壞死感染和持續(xù)性器官衰竭同時(shí)作為2012年亞特蘭大分類的重癥急性胰腺炎（Severe acute pancreatitis，SAP）的評定標(biāo)準(zhǔn)。 方法：上海長海醫(yī)院、南昌大學(xué)第一附屬醫(yī)院是國內(nèi)最大的，以內(nèi)科治療為主的2個(gè)重癥急性胰腺炎診療中心。收集上述2個(gè)中心收治的重癥急性胰腺炎患者資料（2005年1月至2012年12月），共2154例。將收集到的重癥胰腺炎患者（1992年Atlanta分類）按照2012年Atlanta分類重新分類成中度重癥急性胰腺炎（Moderate severe acute pancreatitis，MSAP）及SAP。比較各組間的一般狀況，病因，嚴(yán)重程度評分，器官衰竭，治療情況，住院時(shí)間，院內(nèi)死亡率等指標(biāo)。 結(jié)果：急性胰腺炎的病因仍以膽源性為最常見，約占60.4%。2012年亞特蘭大分類標(biāo)準(zhǔn)的SAP組與MSAP組比較，Ranson評分，APACHEII評分，BISAP評分和Marshall評分均顯著增高，且P值0.00，病情明顯較重，差異均有統(tǒng)計(jì)學(xué)意義。重癥急性胰腺炎（2012年亞特蘭大分類）器官功能衰竭發(fā)生率明顯增高，均為持續(xù)性器官衰竭（48小時(shí)）。中度重癥急性胰腺炎的總體器官衰竭發(fā)生率為33.5%，均為一過性器官衰竭（48小時(shí)）。1992年的亞特蘭大分類的重癥急性胰腺炎器官衰竭的發(fā)生率為50.2%。它的發(fā)生率較2012亞特蘭大分類的重癥急性胰腺炎組明顯減少，較中度重癥急性胰腺炎發(fā)生率增高。三組間均是呼吸衰竭發(fā)生率最高。2012年亞特蘭大分類的重癥急性胰腺炎患者的重癥監(jiān)護(hù)病房監(jiān)護(hù)需要率，血液凈化需要率，機(jī)械通氣需要率，空腸營養(yǎng)需要率，介入引流需要率，均明顯高于中度重癥急性胰腺炎患者。且前者周期比后者長。重癥急性胰腺炎患者的住院時(shí)間也長于中度重癥急性胰腺炎，前者院內(nèi)死亡率（23.2%）明顯高于后者（4.8%）。合并感染的重癥急性胰腺炎（2012年修正的Atlanta分類）組患者病死率達(dá)到41.1%，顯著高于中度重癥急性胰腺炎（2012年修正的Atlanta分類）組的5.9%。胰腺相關(guān)感染，器官功能衰竭及全身炎癥反應(yīng)綜合征是院內(nèi)死亡率的危險(xiǎn)因素。 總結(jié)：2012年亞特蘭大分類能夠更好的反應(yīng)病情嚴(yán)重程度，但是未將胰腺感染因素具體納入胰腺炎分類中。我們建議將2012年修正的Atlanta分類中重癥急性胰腺炎的診斷應(yīng)將胰腺感染同時(shí)納入診斷標(biāo)準(zhǔn)；而不僅僅將持續(xù)的器官衰竭作為主要的判別標(biāo)準(zhǔn)�；蛟S能夠更好，更精確的反應(yīng)病情嚴(yán)重程度和臨床過程，為臨床工作和研究工作帶來更大益處。然而此建議還需要大量的前瞻性研究來證實(shí)。
[Abstract]:Objective: acute pancreatitis is a clinical process and results of variable disease, about 20% of the patients after serious acute pancreatitis. And the mortality of patients with severe acute pancreatitis at a rate of 10-30%. at present, in the United States, there are more than 220 thousand of the patients with acute pancreatitis were admitted to the hospital each year, and acute pancreatitis has been ranked first in hospital related gastrointestinal diseases. And the incidence rate is also growing, especially in severe acute pancreatitis. Although acute pancreatitis has made great progress in treatment, but the mortality rate is still high. However, some researchers believe that the treatment of specific effect is at least partly dependent on the accurate classification. The accurate classification of the severity of acute pancreatitis is very important in clinical work and research. In clinical work, accurate classification to determine the severity of the disease, pay close attention to clinical disease and clinical decision-making process This is very valuable. In clinical studies, has great significance for clinical research object into the accuracy. The severity of acute pancreatitis according to the 1992 Atlanta classification of traditional divided into mild acute pancreatitis and severe acute pancreatitis.2012 taxonomists modify Atlanta severity classification, divided into 3 categories: mild acute pancreatitis, acute pancreatitis and severe acute pancreatitis with moderate.
Objective: the purpose of this study is to apply the two Atlanta classification system were retrospectively analyzed. Compare the clinical results of acute pancreatitis in 1992 Atlanta and 2012 Atlanta classification classification, further evaluation of the two classification systems. Because of mild acute pancreatitis classification standard is not changed, so the study on severe acute pancreatitis do comparison. In addition, we also suggested that the infection of pancreatic necrosis and persistent organ failure at the same time as the 2012 Atlanta classification of severe acute pancreatitis (Severe acute, pancreatitis, SAP) of the evaluation standard.
Methods: the Changhai Hospital of Shanghai, the First Affiliated Hospital of Nanchang University is the largest, with the medical treatment of 2 severe acute pancreatitis patients. Treatment center. The data collection of the 2 center of severe acute pancreatitis (January 2005 to December 2012), a total of 2154 cases were collected. The patients with severe acute pancreatitis (1992 Atlanta classification) according to the 2012 Atlanta classification re classified as moderately severe acute pancreatitis (Moderate severe acute pancreatitis, MSAP) cause the general situation, and SAP. were compared between groups, severity score, organ failure, treatment, hospitalization time, hospital mortality and other indicators.
Results: the etiology of acute pancreatitis with biliary is the most common, accounting for about 60.4%.2012 years, SAP group and MSAP group of the Atlanta classification standard of Ranson score, APACHEII score, BISAP score and Marshall score were significantly increased, and the P value is 0, the disease was heavier, the differences were statistically significant. (severe acute pancreatitis in 2012 the Atlanta classification) significantly increased the incidence of organ failure, are persistent organ failure (48 hours). The overall organ failure in moderately severe acute pancreatitis occurred in 33.5% were transient organ failure (48 hours) the incidence of severe acute pancreatitis group was 2012 Atlanta classification 50.2%. the decreased organ failure of Atlanta.1992 classification of severe acute pancreatitis, with moderate to severe acute pancreatitis incidence rate increased. Among the three groups are the highest incidence of respiratory failure.2012 The Atlanta classification of patients with severe acute pancreatitis in ICU care need rate, blood purification rate need, the need for mechanical ventilation rate, rate of jejunal nutritional needs, need interventional drainage rate, were significantly higher in patients with moderate to severe acute pancreatitis. And the cycle is longer than that of the latter. The hospitalization time of patients with severe acute pancreatitis is longer than that of moderately severe acute pancreatitis, the former hospital mortality (23.2%) was significantly higher than that of the latter (4.8%). Infection of severe acute pancreatitis (Atlanta's revised 2012) group the mortality rate reached 41.1%, significantly higher than that of moderate to severe acute pancreatitis (Atlanta 2012 Amendment) 5.9%. pancreatic infection group, organ failure and systemic inflammatory response syndrome syndrome is a risk factor for hospital mortality.
Summary: the reaction condition of the 2012 Atlanta classification can be better but not the severity of pancreatic infection factors into specific pancreatitis classification. We suggest the diagnosis of Atlanta in the 2012 amendment to the classification of severe acute pancreatitis should be included in the diagnosis of pancreatic infection and standard; not only will continue organ failure as the main criterion may be. Better, more accurate response to disease severity and clinical course, bring greater benefits for clinical work and research work. However, this suggested that larger prospective studies are needed to confirm.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R576

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