Prospective Study of a Protocol for Selection of Treatment of Acute Pancreatitis Based on Scoring of Severity
Prospective Study of a Protocol for Selection of Treatment of Acute Pancreatitis Based on Scoring of Severity
复制标题
基于严重程度评分的急性胰腺炎治疗方案选择的前瞻性研究
作者：
H. Yokoi;T. Naganuma;T. Higashiguchi;S. Isaji;Y. Kawarada
背景/目的：自1994年7月以来，我们一直在进行一项根据严重程度评分选择急性胰腺炎治疗方案的前瞻性研究。方法：选择1994年7月至1998年6月收治的急性胰腺炎患者56例。所采用的方案是基于我们的回顾研究的结果。入院时按日本厚生福利省标准计算预后评分(急性胰腺炎严重程度评分)和APACHE II评分，按方案选择早期治疗。结果：26例胆石性胰腺炎和30例非胆石性胰腺炎中的28例均获成功治疗，效果良好。非胆石性胰腺炎死亡2例。在根据病情严重程度选择早期治疗方案时，建议预后评分在2分以上，APACHE II评分在8分以上时，胆石性胰腺炎宜行胆道引流，非胆石性胰腺炎宜行腹腔灌洗。当出现感染性胰腺坏死时，需要手术治疗。结论：我们基于预后评分和APACHE II评分的急性胰腺炎新的治疗方案对于准确地评估病情严重程度和选择治疗方法是有用的。
Background/Aim: Since July 1994, we have been conducting a prospective study of a protocol for selection of treatment of acute pancreatitis based on scoring of severity. Methods: From July 1994 to June 1998, 56 patients with acute pancreatitis were enrolled in this study. The protocol employed was based on the results of our retrospective study. On admission, the prognosis score (scoring of severity of acute pancreatitis based on the criteria of the Ministry of Health and Welfare of Japan) and APACHE II score were calculated, and early treatment was selected according to the protocol. Results: All of the 26 patients with gallstone pancreatitis and 28 of 30 patients with non-gallstone pancreatitis were successfully treated and had good outcome. There were 2 deaths in non-gallstone pancreatitis. In selection of early treatment according to the scoring of severity, we suggested that when the prognosis score is 2 or more and the APACHE II score of 8 or more, gallstone pancreatitis should be treated by biliary drainage, and non-gallstone pancreatitis by peritoneal lavage. When infected pancreatic necrosis is exhibited, surgery is indicated. Conclusion: Our new management protocol for acute pancreatitis based on the prognosis score and APACHE II score appear to be useful for accurately scoring severity and selecting the treatment methods.