摘要
目的探讨急诊床旁超声心动图心功能评估对急性胰腺炎(acute pancreatitis, AP)严重程度的预测效果。方法前瞻性收集2018年6月至2020年12月首都医科大学附属北京世纪坛医院急诊科收治的急性胰腺炎患者临床资料。根据2012年亚特兰大国际会议修订后的亚特兰大分类, 将患者分为轻症急性胰腺炎(mild acute pancreatitis, MAP)、中度重症急性胰腺炎(moderate severe acute pancreatitis, MSAP)、重症急性胰腺炎(severe acute pancreatitis, SAP)三组, 比较三组间综合评分指标、血液相关指标、超声心动图相关指标的差异, 并采用Logistic回归分析SAP的预测因素, 绘制受试者工作特征曲线并分析曲线下面积(AUC), 评价其预测效能。结果共纳入患者116例, SAP组与非SAP组(MAP组+MSAP组)比较, APACHE Ⅱ评分、SOFA评分、Ranson评分、降钙素原、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ, cTnⅠ)、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NTproBNP)、左心室舒张末内径、A峰、E/A、E’’/A’’、每搏输出量(stroke volume, SV)均差异有统计学意义(P<0.05), 而左心室收缩末内径、E峰、左室射血分数三组之间比较, 差异无统计学意义(P>0.05)。SOFA评分、Ranson评分、cTnⅠ、NTproBNP、E’’/A’’、SV为AP严重程度的重要预测因素(均AUC>0.7)。超声心动图心功能评估综合指标(E’’/A’’+SV, AUC=0.969)和评分综合指标(SOFA评分+Ranson评分, AUC=0.989)对SAP的预测性优于血液综合指标(cTnI+NTproBNP, AUC=0.732)。结论超声心动图心功能评估指标E’’/A’’和SV对SAP有较好的预测价值, 在AP患者临床治疗中具有一定的指导意义。
Objective To investigate the predictive value of emergency bedside echocardiography on acute pancreatitis(AP)severity by assessing cardiac dysfunction.Methods The clinical data used in this study was prospectively collected from AP patients in the Emergency Department of Beijing Shijitan Hospital,Capital Medical University from June 2018 to December 2020.According to the Atlanta Classification revised at the 2012 Atlanta International Conference,patients were divided into three groups of mild acute pancreatitis(MAP),moderate-severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP).The differences of comprehensive score index,blood-related index,and echocardiography-related index were compared among the three groups.Besides,the predictive factors of SAP were analyzed by Logistic regression,receiving operating characteristic(ROC)curves of subjects were drawn,and the area under the curve(AUC)was analyzed to evaluate the predictive efficiency.Results A total of 116 patients were enrolled in this study.Compared with the non-SAP group(MAP group+MSAP group),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential organ failure assessment(SOFA)score,Ranson score,procalcitonin,cardiac troponin Ⅰ(cTnⅠ),N-terminal pro-brain natriuretic peptide(NTproBNP),EDD,A-peak,E/A,E′/A′,and stroke volume(SV)exhibited significant differences(all/5<0.05).There was no significant difference in end-systolic diameter,E-peak,and left ventricular ejection fraction among the three groups(P>0.05).Logistic regression analysis revealed that SOFA score,Ranson score,cTnl,NTproBNP,E′/A′,and SV were important predictors of AP severity(all AUC>0.7).Moreover,the predictive value of echocardiography cardiac function assessment index(E′/A′+SV,AUC=0.969)and score index(SOFA score+Ranson score,AUC=0.989)for SAP was better than that of blood index(cTnⅠ+NTproBNP,AUC=0.732).Conclusions Echocardiographic indicators E′/A′and SV have acceptable predictive values for SAP,providing certain guiding significance f
作者
黄隽敏
巩欣媛
刘滕飞
秋爽
王真
Huang Junmin;Gong Xinyuan;Liu Tengfei;Qiu Shuang;Wang Zhen(Department of Emergency Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100032,China;Department of Science and Education,Tianjin Fist Central Hospital,Tianjin 300192,China;Department of Cardiology Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100032,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第1期66-72,共7页
Chinese Journal of Emergency Medicine
基金
中国铁路总公司科技研究开发计划课题(J2017Z608)
首都医科大学附属北京世纪坛医院院青年基金(2017-q27)
首都医科大学附属北京世纪坛医院中心实验室开放课题(2019-KF28)。
关键词
急性胰腺炎
急诊床旁超声心动图
心功能障碍
预测
Acute pancreatitis
Emergency bedside echocardiography
Cardiac dysfunction
Predictive
