本文選題：中度急性胰腺炎 + MCTSI　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：肯定通過胰腺增強(qiáng)CT檢查改良CT嚴(yán)重指數(shù)（MCTSI）對(duì)中度急性胰腺炎的診斷價(jià)值，探討中度急性胰腺炎患者M(jìn)CTSI與臨床病情的相關(guān)性。為臨床制定合理治療方案及判斷預(yù)后起指導(dǎo)性作用。方法：隨機(jī)選取2011年1月—2014年2月入住四川省醫(yī)學(xué)科學(xué)院四川省人民醫(yī)院消化內(nèi)科198例確診為中度急性胰腺炎的患者，其中男性146例，女性52例，年齡32歲-76歲，平均（49±13）歲。于發(fā)病48h-72h行胰腺增強(qiáng)CT檢查，，收集影像學(xué)資料及臨床資料[包括局部或全身并發(fā)癥：急性胰腺炎胰周液體積聚(APFC)、急性壞死物積聚(ANC)、胰腺假性囊腫、包裹性壞死(WON)和胰腺膿腫、胸腔積液、胃流出道梗阻、消化道瘺、腹腔出血、假性囊腫出血、脾靜脈或門靜脈血栓形成、壞死性結(jié)腸炎、全身炎癥反應(yīng)綜合征（SIRS）、全身感染、腹腔內(nèi)高壓(IAH)或腹腔間隔室綜合征(ACS)、胰性腦病(PE)及一過性臟器功能衰竭（呼吸、循環(huán)、腎臟）]，并對(duì)比分析，觀察MCTSI與并發(fā)癥、生化指標(biāo)變化的結(jié)果，與臨床評(píng)分（APACHEⅡ、Rason、BISAP）的相關(guān)性。結(jié)果：1、伴有單個(gè)或多個(gè)并發(fā)癥的病例MCTSI集中出現(xiàn)在4、6、8、10分值段，構(gòu)成比分別為35.6%；42%；18.7%；3.7%。中度急性胰腺炎MCTSI分值越高，臨床病情越重。2、MCTSI在8、10分值組的病例中，血尿淀粉酶顯著下降，且10分病例下降更明顯（P＜0.05）；而CRP數(shù)值顯著升高，且10分組升高更明顯（P＜0.05）；血鈣數(shù)值顯著下降，且10分組下降更明顯（P＜0.05）；差異均有統(tǒng)計(jì)學(xué)意義。表明MCTSI分值越高，反應(yīng)中度急性胰腺炎炎癥程度的生化指標(biāo)變化越顯著，病情越重。3、MCTSI與APACHEⅡ評(píng)分呈正相關(guān)性（χ2=11.9572;P=0.0177;相關(guān)系數(shù)=0.1549)，ACHEⅡ評(píng)分≥8分的病例，MCTSI集中出現(xiàn)在4～10分值組，表明：MCTSI越高，APACHEⅡ臨床評(píng)分越高，病情越重。4、MCTSI與Rason評(píng)分呈正相關(guān)性（χ2=9.7670;P=0.0445;相關(guān)系數(shù)=0.1266)，Rason評(píng)分≥3分的病例，MCTSI集中出現(xiàn)在4～10分值組，表明：MCTSI越高，Rason評(píng)分越高，病情越重。5、MCTSI與BISAP評(píng)分呈正相關(guān)性（χ2=10.6566;P值=0.0307;相關(guān)系數(shù)=0.1461)，BISAP評(píng)分≥3分的病例，MCTSI集中出現(xiàn)在4～10分值組，表明：MCTSI越高，BISAP評(píng)分臨床評(píng)分越高，病情越重。結(jié)論：胰腺增強(qiáng)CT檢查MCTSI評(píng)估系統(tǒng)是診斷中度急性胰腺炎最簡便、準(zhǔn)確的方法，能直接發(fā)現(xiàn)胰腺實(shí)質(zhì)及周圍的病變。將CT炎性和壞死分級(jí)、MCTSI、臨床評(píng)分相結(jié)合可以明確診斷，對(duì)病情的評(píng)估、臨床分型、判斷預(yù)后及指導(dǎo)治療具有重要的臨床價(jià)值。
[Abstract]:Objective: to evaluate the diagnostic value of modified CT severity index (MCTSII) in patients with moderate acute pancreatitis (MCTSI), and to explore the correlation between MCTSI and clinical conditions in patients with moderate acute pancreatitis. It plays a guiding role in making reasonable treatment plan and judging prognosis in clinic. Methods: 198 patients with moderate acute pancreatitis were randomly selected from January 2011 to February 2014 in the Department of Digestive Medicine, Sichuan Provincial people's Hospital, Sichuan Academy of Medical Sciences, including 146 males and 52 females, aged from 32 to 76 years with an average of 49 鹵13 years. Pancreatic enhanced CT was performed on 48h-72h. Imaging and clinical data were collected [including local or systemic complications: acute pancreatitis with peripancreatic fluid accumulation, acute necrotic accumulation with ANC, pancreatic pseudocyst, encapsulated necrotic WON] and pancreatic abscess. Pleural effusion, obstruction of gastric outflow tract, gastrointestinal fistula, abdominal hemorrhage, pseudocyst hemorrhage, splenic vein or portal vein thrombosis, necrotizing colitis, systemic inflammatory response syndrome, systemic infection, Intraperitoneal hypertension (IAH) or celiac septum syndrome (ACS), pancreatic encephalopathy (PED) and transient organ failure (respiratory, circulatory, renal) were compared and analyzed, and the results of MCTSI, complications and biochemical indexes were observed. Correlation with clinical score Apache 鈪

本文編號(hào)：2037040