患有血清脂酶轻度升高和急性胰腺炎的急诊患者
Saqer M Althunayyan1, Abdulmajed K Alali1, Laila K Alanazi1
1From the Accidents and Trauma Department (Althunayyan), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University; from the Emergency Department (Alali, Alanazi, Alkhalifah, Mashdali), Dr. Sulaiman Al-Habib Hospital Al-Ryyan; from the Emergency And Urgetn Care Department (AlAsiri), Health Holding Company; from the Department of Emergency Medicine (Malabarey) College of Medicine, King Saud University; and from the Department of Emergency Medical Services (Mobrad), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia.
急性胰腺炎 (AP) 影响6.3%的临界脂酶水平的患者. 酒精是最强的预测因素,强调了诊断AP的风险分层分数的必要性.
科学领域:
- 胃肠病学 胃肠病学
- 紧急医疗 紧急医疗
- 临床诊断 临床诊断 临床诊断
背景情况:
- 升高的脂酶水平低于正常的上限 (ULN) 的3倍,可能会导致急性胰腺炎 (AP) 的诊断挑战.
- 准确的诊断和风险分层对于有效管理AP至关重要.
- 了解预测因素和结果对于改善患者护理至关重要.
研究的目的:
- 为了确定急性胰腺炎 (AP) 的发病率在临界升高的脂酶水平的患者中.
- 在这个队列中确定与AP诊断相关的预测因素.
- 分析AP患者的结果,包括住院和死亡率.
主要方法:
- 一项多中心的6年后期研究,涉及成年患者,其脂酶水平在急诊室 (ED) 的80-240 IU/L之间.
- 经过修订的亚特兰大分类被用来确认AP诊断在最初的ED访问后的72小时内.
- 计算机断层扫描 (CT),重复的脂酶水平和超声波用于病例确认.
主要成果:
- 在1082名患者中,6.3%被诊断为AP. 其中,有36.3%的患者被住院治疗,6%的患者需要住院治疗,0.2%的患者死亡.
- 酒精消费是AP最强的预测因素 (调整后的几率比:3.9-45.6),其次是白细胞计数,男性性别和更高的脂酶水平.
- 关键结局包括ICU入院 (11.8%) 和住院死亡率 (72小时内1例死亡),与慢性心脏病,肥胖,发烧和低心率相关.
结论:
- 6.3%的研究队列被诊断为AP,CT是主要的诊断工具.
- 酒精成为预测AP最重要的风险因素.
- 需要一个验证的预测得分来分层AP风险在患者的脂酶水平低于3 ULN.
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