治疗干预评分系统(TISS-28)在外科重症监护病房急性胰腺炎患者中的临床应用研究

王雪飞; 任为正; 赵庆华; 赵永生; 刘志伟; 何蕾

doi:10.3969/j.issn.2095-5227.2021.09.010

治疗干预评分系统(TISS-28)在外科重症监护病房急性胰腺炎患者中的临床应用研究

Clinical application of TISS-28 in patients with acute pancreatitis in a surgical intensive care unit

摘要

摘要:
背景急性胰腺炎患者病情复杂，治疗周期长，部分患者入住重症监护室(intensive care unit，ICU)仅为了病情监护，如果能提升早期对疾病严重程度及预后的评估，将会促进胰腺炎患者ICU医疗资源的合理使用。
目的探讨治疗干预评分系统(TISS-28)在ICU急性胰腺炎患者中的临床应用。
方法回顾性分析2015-2019年解放军总医院第一医学中心肝胆外科ICU收治的急性胰腺炎患者。按照治疗干预评分系统(TISS-28)分值高低分为密切监护组和非密切监护组，比较两组的住院天数、ICU天数、呼吸支持、肾功能支持、循环支持情况以及预后，同时密切监护组内存活和死亡患者并进行比较。
结果共入组360例急性胰腺炎患者，密切监护组134例，其中男性97例，占72.4%，平均年龄(47.8 ± 15.6)岁；非密切监护组226例，男性160例，占70.8%，平均年龄(45.8 ± 14.1)岁。与非密切监护组比较，密切监护组均为重症胰腺炎(severe acute pancreatitis，SAP)，平均年龄大(47.8 ± 15.6)岁 vs (44.5 ± 13.0)岁，P=0.004，体质量指数高24.6(22.0～27.7) kg/m² vs 23.4(21.0～26.0) kg/m²，P=0.018，发病至收治时间短24(3～47) d vs 45(20～74) d，P＜0.001，住院时间长30(18～62) d vs 24(15～41) d，P=0.006，ICU时间长10(3～23) d vs 2(0～5) d，P＜0.001。43例患者在院期间死亡，死亡率为11.9%(43/360)，均为密切监护组。死亡患者入院当日TISS评分24(19～40) vs 18(14～26)，P＜0.01 及围术期TISS评分47(37～53) vs 22(18～26)，P＜0.01较存活患者更高。
结论对于在外科ICU中的SAP患者，TISS-28的评分对于评估病情有一定参考价值，可根据TISS-28评分项目，进行分级治疗，密切监护患者有赖于ICU病房支持，应尽量避免非密切监护患者对ICU资源的占用。

Abstract:
Background Patients with acute pancreatitis have complicated conditions and long treatment periods, and some patients are admitted to the intensive care unit (ICU) only for monitoring. If the early assessment of disease severity and prognosis can be improved, it will promote the rational use of medical resources for patients with pancreatitis in ICU.
Objective To investigate the clinical application of the treatment intervention score system (TISS-28) in ICU patients with acute pancreatitis.
Methods From 2015 to 2019, clinical data about patients with acute pancreatitis who were admitted to our hospital were retrospectively analyzed. Patients were divided into the intensive care group and non-intensive care group based on the TISS-28 scoring system. The length of hospital stays, ICU days, respiratory support, renal function support, circulatory support, and prognosis were compared between the two groups, and the survival and death of patients in the intensive care group were also compared.
Results A total of 360 patients with acute pancreatitis were enrolled. There were 134 patients in the intensive care group, including 97 males (72.4%), with an average age of (47.8 ± 15.6) years. There were 226 patients in the non-intensive care group, including 160 males (70.8%), with an average age of (45.8 ± 14.1) years. Compared with the non-intensive care group, all patients in the intensive care group had severe acute pancreatitis (SAP), with significantly higher average age (47.8 ± 15.6 yrs vs 44.5 ± 13.0 yrs, P=0.004), higher BMI (24.622.0-27.7 kg/m² vs 23.421.0-26.0 kg/m², P=0.018), shorter hospitalization time from onset to admission (243-47 d vs 4520-74 d, P＜0.001), more extended hospital stays (3018-62 d vs 2415-41 d, P=0.006) and ICU days (103-23 d vs 20-5 d, P＜0.001). Forty-three patients died during hospitalization, with the mortality rate of 11.9% (43/360), all the dead cases were in the intensive care group. The TISS-28 scores of the dead patients on the day of admission and perioperative period were significantly higher than those of the survival patients (2419-40 vs 1814-26, 4737-53 vs 2218-26, P＜0.01, respectively).
Conclusion For SAP patients in surgical ICU, TISS-28 score has a particular reference value for evaluating the condition. According to the TISS-28 scoring items, graded treatment can be carried out. Intensive care patients can depend on ICU support, while non-intensive care patients should avoid the occupation of ICU resources.

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