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目的:探讨急性胰腺炎(AP)患者病情严重程度与胸腔积液的相关性。方法:回顾性分析云南省第三人民医院2008年1月至2014年12月收治的492例AP患者的临床资料,以APACHEⅡ评分、CT严重指数(CTSI)两种评分系统评估患者病情严重程度,探讨其与胸腔积液的关系。结果:492例AP患者中,并发胸腔积液者368例,无胸腔积液者124例,胸腔积液的发生率为74.8%。病情轻重不同组胸腔积液的发生率比较均有统计学意义(P<0.05)。病情越重者胸腔积液程度越重。胸腔积液程度与APACHEⅡ评分(r=0.775,P<0.01)、CTSI(r=0.525,P<0.05)呈正相关。Logisitc回归分析显示高APACHEⅡ、高CTSI是发生胸腔积液的独立危险因素。在判断AP并发胸腔积液患者的预后时,APACHEⅡ评分、CTSI以及两者联合评分的受试者工作特征曲线下面积分别为0.798、0.687、0.812。APACHEⅡ评分、联合评分与CTSI相比差异均有统计学意义(P<0.05)。结论:AP患者病情严重程度与胸腔积液密切相关,综合运用APACHEⅡ评分、CTSI评估病情并积极干预有助于改善患者的预后。
Objective: To investigate the relationship between the severity of pleural effusion and the severity of acute pancreatitis (AP). Methods: The clinical data of 492 AP patients admitted to the Third People ’s Hospital of Yunnan Province from January 2008 to December 2014 were retrospectively analyzed. The severity of the patients was assessed by the APACHE Ⅱ score and the CT severity index (CTSI) Explore its relationship with pleural effusion. Results: Of the 492 AP patients, 368 had pleural effusion, 124 had pleural effusion, and the incidence of pleural effusion was 74.8%. The severity of pleural effusion in different groups were statistically significant (P <0.05). The more severe the more pleural effusion. The degree of pleural effusion was positively correlated with APACHEⅡscore (r = 0.775, P <0.01) and CTSI (r = 0.525, P <0.05). Logistic regression analysis showed that high APACHE II and high CTSI were independent risk factors for pleural effusion. In determining the prognosis of patients with AP complicated with pleural effusion, APACHE Ⅱ score, CTSI and the combined score of the two subjects under the operating characteristic curve area were 0.798,0.687,0.812. APACHE Ⅱ score, joint score compared with CTSI were statistically significant (P <0.05). Conclusion: The severity of AP in patients with pleural effusion is closely related to the use of APACHE Ⅱ score, CTSI assessment of the disease and active intervention will help improve the prognosis of patients.