| ObjectivesTo analyze the pathogenesis, explore the severity scores (APACHE II score, Ranson criteria, and Balthazar CT grading) of severe acute pancreatitis (SAP) patients in our hospital for the period of January,2009 to December,2010.Determine the abdominal circumference, Intra-abdominal pressure, abdominal compartment syndrome (ACS) and the relationship of ACS and severity assessment scores.Explore the significance of monitoring intra-abdominal pressure, therapeutic out come and prognosis of SAP patient in our medical facility.MethodsClinical analysis of sixty seven patients (41 male and 26 female), at the age of 20-76 years, were diagnosed as severe acute pancreatitis (SAP) according to the "Atlanta classification of acute pancreatitis" between January,2009-December, 2010 in Xiangya hospital of Central South University. We undertook the measurement of the urinary bladder pressure (Indirect IAP measurement) as an index of intra-abdominal pressure and monitoring of severity scores for evaluation of therapeutic outcome and prognosis. We calculated the severity assessment scores and abdominal circumference so as to observe the chance in distension condition.ResultsAmongst sixty seven cases in this analysis,61.2%(41/67) were male,38.8% (26/67) were female, age (20-75) years. Mean age (49.7±14.4 y). Total of 49.3% (33/67) patients were either directly admitted or transferred to intensive care unit (ICU) of our hospital after admission. From onset of disease to admission time was from 1-30 days, average onset time was 5.2±7.1 days. On hospitalization period, the longest hospital stay was 60 days while the shortest period was 1 day; Average hospital stay was 11.1±8.3 days.Etiologically,64.2%(43/67) were biliary,19.4%(13/67) were hyperlipidemic, and 11.94%(8/67) were alcoholic. Combination of biliary stone; alcohol abuse and hyperlipdemia account for 13.43%(9/67). Idiopathic cause accounts for 6.0%(4/67) while 1.5%(1/67) was induced by pregnancy.Positive cases for APACHEⅡscore (>8) and Ranson criteria (>3), for severity assessment were not statistically significant (P=0.13). APACHEⅡscore and Balthazar CT grading were statistically significant (P<0.01). Balthazar CT grading and Ranson criteria were statistically significant (P<0.01). Among the three parameters for severity assessment, Balthazar CT grading was more sensitive in diagnosis of SAP (90.2%), while APACHEⅡscore and Ranson criteria were 56.7% and 58.2% respectively.Comparison of the mortality rate for different groups of APACHEⅡ(0-7,8-14, >14) showed that the results were statistically significant at P<0.05. Mortality rate was highest (50%), in the group with APACHEⅡscore>14. Comparison of the mortality rate for different groups of Ranson score (<3,3-5,>5) showed that the results were not statistically significant (P>0.05) between the groups with Ranson score 3-5 and >5; but statistically significant at P<0.05 for the groups with Ranson score <3 and >5. However, mortality rate was highest (33.3%), in the group with Ranson score >5. Comparison for the mortality rates for different groups of Balthazar between groups (C and D); show that P >0.05, the results was not statistically significant for the two groups; between groups (D and E); P=0.01, the results for mortality of the groups was statistically significant. Comparison between groups (C and E); P=0, the results for the mortality of the groups was statistically significantRegarding abdominal compartment syndrome, we compared the means of intra-abdominal pressure (IAP), APACHE II score and abdominal circumference of Intra-abdominal hypertension (IAH) group and abdominal compartment syndrome (ACS) group. The results of means of IAP and APACHE II score were statistically significant, P<0.001. Abdominal circumference and APACHE II score were not statistically significant at P<0.05, between the IAH and ACS group. Mortality rates of patients with ACS were significantly higher than those with IAH, P=0.01.Pertaining to the mortality, there were eleven deaths out of the sixty-seven patients, representing 16.4%. The most the deaths were due multiple organ dysfunction syndromes resulting from intra-abdominal infection, acute renal failure, adult respiratory distress syndrome and massive hemorrhage. Amongst these eleven patients, six died in hospital while the remainder discontinued treatment at varying length of hospitalization.Conclusion1. For the diagnostic and assessment of severity of SAP, Balthazar CT grading is superior and more sensitive to Ranson criteria and APACHEⅡscore.2. Measurement of IAP should be carried out on all SAP patients that present with higher APACHE II score, for early management of ACS. Higher APACHEⅡscore is correlated with development of abdominal compartment syndrome (ACS) and high mortality.3. Measurement of abdominal circumference does not play a significant role in development and monitoring of abdominal compartment syndrome in SAP patients. Hence abdominal circumference is not a suitable candidate for severity assessment.
|
PDF Full Text Request