急性胰腺炎严重度评价及治疗.ppt

单击此处编辑母版文本样式,第二级,第三级,第四级,Page,*,单击此处编辑母版标题样式,急性胰腺炎严重度评价及治疗,参考文献：中国急性胰腺炎诊治指南,(,草案,)-2003,急性胰腺炎,(AP),是指多种病因引起的胰酶激,活,继以胰腺局部炎症反应为,主要特征,伴或不伴有其他器,官功能改变的疾病。,病因,常见病因,:,胆石症 酒精 高脂血症,其他病因,:,ERCP,外伤 胰腺断裂 壶腹周围癌 胰腺癌,壶腹乳头括约肌功能不良 药物和毒物,高钙血症 腹部手术后,特发性胰腺炎,临床术语,轻症,AP(MAP),重症,AP(SAP),暴发性胰腺炎,(fulminate pancreatitis),严重度评价,CT,分级,Ranson,评分,APACHE,评分,瑞金医院,CT,评分标准,Binder,并发症评分,CT,分级,A,胰腺正常,B,胰腺局部或弥漫性肿大，但胰周正常,C,胰腺实质及周围炎症改变,胰,周轻度渗出,D,除C 级外,胰周渗出显著,胰腺实质内或,胰周单个液体积聚,E,广泛的胰腺内、外积液,包括胰腺,和脂肪坏死,胰腺脓肿,A,C,级,:,临床上为,MAP;D,E,级,:,临床上为,SAP,A,、,B,组无并发症，死亡率,D,级,8.3%,，,E,级,17.4%,Ranson,评分表,入院时：,年龄,55,岁，,WBC,16000/mm,3,，血糖,10mmol/L,LDH,350IU/L,，,SGOT,250IU/L,48h,：,HCT,下降,10%,，血钙,2mmol/L,PaO,2,8kPa(60mmHg),碱缺乏,4mmol/L,BUN,增加,5mg/dl,，体液隔离或丧失,6L,注：凡符合表中标准的，每项记,1,分，体液隔离或丧失计算公式,=48h,入水量（,48h,胃肠减压量,48h,尿量,48h,其他引流量）；死亡率,02,分,1%,，,34,分（,SAP,），,15%,，,56,分，,40%,6,分，,100%,。,APACHE,评分系统,A,、生理学变量,0,分,1,分,2,分,3,分,4,分,1,、肛量,(),3638.4,34.035.9,38.538.9,3233.9,3031.9,3940.9,29.9,41,2,、平均动脉压,(mmHg),70109,5069,110129,130159,59,160,3,、心率,(,次,/min),70109,5569,11039,4054,140179,39,180,4,、呼吸率,(,次,/min),1224,1011,2534,69,3549,5,50,5,、氧合作用,(mmHg),FiO,2,70,200,6170,200349,5560,350499,55,500,6,、动脉血,pH,7.337.49,7.57.59,7.257.32,7.157.24,7.607.63,7.7,7,、血清钠,(mmol/L),130149,150154,120129,155159,111119,160179,110,180,8,、血清钾,(mmol/L),3.55.4,3.03.4,5.55.9,2.52.9,6.06.9,2.9,7,APACHE,评分系统,A,、生理学变量,0,分,1,分,2,分,3,分,4,分,9,、血清肌酐,(mg/dl),(,急性肾衰加倍计分）,0.61.4,0.6,1.51.9,2.03.4,3.5,10,、血细胞比容,(%),3045.9,4649.9,2029.9,5059.9,20,60,11,、白细胞计数,(10,3,/mm,3,),314.9,1519.9,12.9,2039.9,40,1,12,、,15-Glasgow,评分,如无动脉血气分析则测静脉血,HCO,3,(mmolg/L),2231.9,3240.9,1821.9,1517.9,4151.9,15,52,B,、年龄因素评分：,0,分,2,分,3,分,5,分,6,分,44,岁,4554,岁,5564,岁,6474,岁,75,岁,C,、慢性健康状况评分,肝,心血管,呼吸,肾,免疫,2,分,5,分,2,分,5,分,2,分,5,分,2,分,5,分,2,分,5,分,APACHE(acute physiology and chronic health evaluation),评分,=A+B+C,（,8,分）,瑞金医院,CT,评分标准,CT,分级,胰腺坏死范围计分,胰外侵犯计分,积分,级,1/3,计,4,分,2,区计,2,分,5,级,/3,计,4,分,3,区计,3,分,710,1/32/3,计,8,分,2,区计,2,分,710,1/32/3,计,8,分,3,区计,3,分,1114,级,全胰腺计,12,分,2,区计,2,分,1114,级,全胰腺计,12,分,3,区计,3,分,15,注：将胰腺分为,12,个区，每个区打,1,分，将胰外侵犯分,7,个区，每个区打,1,分。胰外侵犯：每区为,1,分。共,7,分。,1,、小网膜；,2,、肠系膜血管根部；,3,、左侧结肠后区；,4,、右侧结肠后区；,5,、左肾区；,6,、右肾区；,7,、后腹膜分离,严重度分级,轻症,AP(MAP),Ranson,评分,3,或,APACHE2,评分,50%,坏死,+,感染,胰腺无菌坏死但病情稳定,胆源性胰腺炎治疗不缓解,临床表现恶化,鉴别诊断,MOF,六、治疗,谢谢大家,