~Teachingcenter的醫學筆記~

電腦斷層嚴重度指數
CT findings and grading of acute pancreatitis (CT severity index (CTSI))
可以同時參考：http://teachingcenter1.pixnet.net/blog/post/348746741:
Score of non-contrast CT findings (Balthazar grade)：
= Grade A → Score: 0
-- 正常
-- Normal pancreas-normal size, sharply defined, smooth contour, homogeneous enhancement, retroperitoneal peripancreatic fat without enhancement
= Grade B → Score: 1
-- 胰臟腫大
-- Focal or diffuse enlargement of the pancreas, contour may show irregularity, enhancement may be inhomogeneous but there is on peripancreatic inflammation
= Grade C → Score: 2
-- 胰臟周圍脂肪組織發炎
-- Peripancreatic inflammation with intrinsic pancreatic abnormalities
= Grade D → Score: 3
-- 不正常的胰臟內或胰臟外積水
-- Intrapancreatic or extrapancreatic fluid collections
= Grade E → Score: 4
-- 不正常的積水(甚至空氣)區域有兩處以上
-- Two or more large collections of fluid/gas in the pancreas or retroperitoneum

Necrosis score：
= Based upon contrast enhanced CT
-- Necrosis 0% → Score 0
-- Necrosis < 33% → Score 2
-- Necrosis 33~50% → Score 4
-- Necrosis > 50% → Score 6

CT severity index (CTSI) = Score of non-contrast CT findings + Necrosis score
MAX = 10，6分以上時，代表為嚴重的胰臟炎
-- 0~3：輕微，死亡率3%以上
-- 4~6：中等，死亡率6%以上
-- 7~10：嚴重，死亡率17%以上
 (Adapted from Balthazar, etc. Radiology 1990; 174:331.)

急性胰臟炎嚴重度評估：Ranson's score
1.剛住院(入急診)的評估Criteria on admission：
- 大於55歲(Age older than 55 years)
- 白血球超過一萬六(WBC count >16,000 mm³)
- 血糖超過200 mg/dL (Blood glucose >200 mg/dL)
- 血清乳酸去氫酶超過350 (Serum lactate dehydrogenase (LDH) >350 IU/L)
- 血清天門冬胺酸轉胺酶超過250 (Aspartate aminotransferase (AST)  >250 IU/L)
2.經過48小時候的評估Criteria during first 48 hours：
- 血球比容值下降超過10% (Hematocrit fall >10%)
- 血中尿素氮上升超過5 mg/dL ((Blood Urea Nitrogen (BUN) increase > 5 mg/dL)
- 血清鈣小於8 mg/dL (Serum calcium <8 mg/dL)
- 動脈血氧分壓小於60 mmHg (Arterial pO2 <60 mmHg)
- 鹼缺乏超過4 mEq/L (Base deficit >4 mEq/L)(以HCO₃ 24 mEq/L為基準)
- 體液流失超過6公升(Estimated fluid sequestration >6 L)
= 以上1.和2.中每一項為一分
-- 0~2分 → 2% mortality
-- 3~4分 → 15% mortality
-- 5~6分 → 40% mortality
-- 7分以上 → 100% mortality

嚴重胰臟炎為以下三項中任一項Severe pancreatitis
= Ranson's criteria:>=3
= APACHE score>=8
= Balthazar grade E

其他預後因子：
= 年齡越大者預後越差、死亡率越高
= 酒精性胰臟炎，因壞死的風險增加，比結石阻塞性胰臟炎預後差
= 肥胖BMI＞30者，併發症及死亡率較高
= 血比容(Hct)並不是越高越好，在住院24小時內，Hct高於正常值5%以上者，代表仍然嚴重脫水，發生重度急性胰臟炎的風險高
= 疾病發作後的48小時CRP仍大於150 mg/L，重度急性胰臟炎風險較高
= 起初的24小時，BUN增加超過5 mg/dL，代表壞死嚴重，死亡率高
= 電腦斷層嚴重度指數(CTSI)直接評估胰臟壞死，壞死越嚴重預後越差