Predicting the severity of pediatric acute pancreatitis: are we there yet?
Predicting the severity of pediatric acute pancreatitis: are we there yet?
复制标题
预测小儿急性胰腺炎的严重程度：我们做到了吗？
DOI：
10.1097/mpg.0b013e318291ff40
复制
发表时间：
2013
影响因子：
2.9
通讯作者：
Uc,Aliye
中科院分区：
文献类型：
--
作者：
Uc,Aliye
直到最近，胰腺炎被认为是一种罕见的儿童疾病。这一概念随着一项单中心研究的发表而改变，该研究报道了1993年至1998年间儿童胰腺炎入院人数从5人增加到133人(1)，随后在美国其他中心发表了相同的趋势（2-4）。目前，儿童胰腺炎的发病率估计与成人胰腺炎的发病率相近（1 / 10,000美元）。虽然儿童急性胰腺炎通常是一种自限性疾病，但也有一部分儿童会出现严重的胰腺炎症和坏死，引发全身炎症反应综合征和多器官功能衰竭（主要是休克、肾功能衰竭、肺功能不全）。在已发表的系列研究中，发生严重急性胰腺炎的儿童百分比是可变的（6%-25%）。这种差异可能是不同病因、转诊模式和不同中心专业知识的结果。由于严重急性胰腺炎患者的发病率和死亡率急剧上升，评分系统已经发展到预测严重程度。这使医生能够识别有发生严重并发症风险的患者，开始密切监测，进行液体复苏，并尽早提高护理水平。仔细选择患者和早期干预可以改善重症急性胰腺炎的预后。有几种评分系统可用于评估成人胰腺炎的严重程度，包括Ranson，格拉斯哥，改良格拉斯哥，急性胰腺炎严重程度床边指数和APACHE II。Ranson标准可用于入院时和48小时内评估预后。这些评分系统包含的标准（例如，年龄大于55岁；体液不足6升）不容易适用于儿童。DeBanto等人(5)首次在急性胰腺炎患儿中评估了胰腺炎评分系统。他们评估了Ranson的表现，并修改了格拉斯哥评分来预测疾病的严重程度，并与他们制定的标准进行了比较
Until recently, pancreatitis was considered an uncommon disease of childhood. That concept changed with the publication of a single-center study reporting an increased number of admissions for pediatric pancreatitis from 5 to 133 patients between 1993 and 1998 (1) and the subsequent publication of identical trends at other centers in the United States (2–4). The incidence of pancreatitis in children is now estimated to be around the incidence of pancreatitis in adults ($1 in 10,000). Although the pediatric acute pancreatitis is generally a selflimited condition, a subset of children develops severe pancreatic inflammation and necrosis, triggering systemic inflammatory response syndrome and multiorgan failure (mainly shock, renal failure, pulmonary insufficiency). The percentage of children who develop severe acute pancreatitis is variable in published series (6%–25%). This variation is probably the result of different etiologies, referral patterns, and expertise at various centers. Because morbidity and the mortality increase sharply in patients with severe acute pancreatitis, scoring systems have been developed to predict the severity. This enables the physicians to identify patients at risk for developing severe complications, initiate close monitoring, fluid resuscitation, and increase the level of care as early as possible. Careful selection of patients and early intervention can improve the outcome from severe acute pancreatitis.There are several scoring systems available to assess the severity of pancreatitis in adults, including Ranson, Glasgow, modified Glasgow, Bedside Index of Severity in Acute Pancreatitis, and APACHE II. Ranson criteria can be used on admission and within 48 hours to assess the prognosis as well. These scoring systems contain criteria (ie, age older than 55 years; fluid deficit> 6 L) that are not easily applicable to children. Pancreatitis scoring systems were first assessed in children with acute pancreatitis by DeBanto et al (5). They evaluated the performance of Ranson and modified Glasgow scores to predict the disease severity and compared with the criteria they have developed