Procena kliničkog značaja numeričko bodovnih sistema za procenu težine bolesti i ishoda lečenja bolesnika sa akutnim pankreatitisom

Abstract

Uvod: Akutni pankreatitis (AP) je nagla upala gušterače sa nepredvidivim tokom i neizvesnim ishodom. Cilj: Cilj ove doktorske disertacije je da ispita faktore koji su najjednostavniji za primenu i najobjektivniji za procenu težine AP, predviđanje razvoja komplikacija i ishod lečenja bolesnika u našim uslovima. Metodologija: Istraživanje je sprovedeno kao prospektivna studija u KBC Bežanijska Kosa u Beogradu i obuhvatilo je bolesnike sa dijagnozom AP. Istraživanje je sprovedeno u nekoliko faza: na prijemu (nulti dan), 48, 72 sata, 7 dana i nakon 12 meseci. U studiju su uključeni bolesnici oba pola, stariji od 18 godina. Rezultati: U našem istraživanju je bilo 50 bolesnika od kojih je do otpusta iz bolnice preživelo 84% a umrlo je 16%. Bolesnika muškog pola je bilo 52% a bolesnika ženskog pola 48%. Najčešći uzrok AP bila je kalkuloza žučne. Najveći broj bolesnika (42%), bio je u starosnoj grupi od 66 do 75 godina. Teška forma pankreatitisa je učestalija kod mlađe starosne dobi i sa većim indeksom telesne mase (BMI). Bolesnici koji su imali tešku formu AP su duže bili na mehaničkoj ventilaciji (MV) i duže su lečeni u jedinici intenzivnog lečenja (JIL). Značajno duže su na MV bili bolesnici sa sepsom/septičnim šokom. Vreme preživljavanja je kraće kod bolesnika koji su imali sepsu ili septični šok, koji su bili gojazni i koji su imali tešku formu AP. Zaključak: Primena određenih bodovnih sistema i biomarkera zapaljenja u različitim fazama lečenja ima značaja u proceni predviđanja konačnog ishoda lečenja, težine AP, pojavu komplikacija, dužine boravka u JIL, dužine MV.

Introduction: Acute pancreatitis (AP) is a sudden inflammation of the pancreas with an unpredictable course and an uncertain outcome. Aim: The aim of this doctoral dissertation is to examine the factors that are the easiest to apply and the most objective to assess the severity of AP, predict the development of complications and the treatment outcome of patients in our conditions. Material and methods: The research was conducted as a prospective study at the CHC Bezanijska Kosa in Belgrade and included patients admitted with a diagnosis of AP. The research was conducted in several phases: on admission (zero day), 48 hours, 72 hours, 7 days and after 12 months. The study included patients of both sexes over the age of 18. Results: In our study, there were 50 patients of whom 84% survived discharge from the hospital and 16% died. There were 52% males and 48% females. The most common cause of AP was gallbladder calculosis. The largest number of patients (42%) was in the age group of 66 to 75 years. Severe form of pancreatitis is more common in younger and with increased body mas index (BMI). Patients who had severe AP were longer on mechanical ventilation (MV) and treated longer in the intensive care unit (ICU). Patients who had sepsis / septic shock were significantly longer on MV. Survival time was shorter in patients who had sepsis or septic shock , who were obese and who had severe AP. Conclusion: The use of certain scoring systems and biomarkers of inflammation in different phases of treatment is important in assessing the prediction of the final outcome of treatment, severity of AP, occurrence of complications, length of stay in ICU, length of MV.