4 research outputs found
ΠΠ ΠΠ‘ΠΠΠΠ’ΠΠΠΠΠ ΠΠ‘Π‘ΠΠΠΠΠΠΠΠΠ ΠΠΠΠΠ‘Π’ΠΠΠΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ₯ ΠΠΠ Π£Π¨ΠΠΠΠ Π I Π€ΠΠΠ Π’Π―ΠΠΠΠΠΠ ΠΠ‘Π’Π ΠΠΠ ΠΠΠΠΠ ΠΠΠ’ΠΠ’Π
Background: Acute pancreatitis is one of the most common surgical abdominal diseases. The development of trypsin autoaggression which provokes hemostasis disorders play significant role for pathogenesis of severe acute pancreatitis. The study of biochemical hemostasis-related markers and general homocysteine as a marker of endothelium damage at acute pancreatitis and their influence on development of heavy complications of the I phase of a disease is actual and relevant task. These complications are the reason for about 40% of lethal outcomes.Aims: To study hemostasis disorders and homocysteine as marker of damage of endothelial cells in patients with acute pancreatitis during the initial period of a disease depending on disease severity, the volume of injury of a pancreas, and development of complications.Materials and methods: 127 patients who were divided into two groups: with severe AP and not severe AP. We investigated variables and indicators of hemostasis system: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR) fibrinogen, and homocysteine.Results: The most expressed hemostasis disorders and level of the general homocysteine were registered on 3rd day from the disease onset. On the 7th day, the tendency to decrease in indexes of a coagulative link of a hemostasis and decrease in level of the general homocysteine was registered in patients with severe acute pancreatitis. There were correlative communications of high and average degree between the volume of a pancreatonecrosis and violation of a hemostasis on 3rd day from the disease onset, and the level of the general homocysteine rS=0.94 (p1=0.001). In patients with severe pancreatitis, systemic complications of different degree of expressiveness were observed in 69.57% of cases. There were average and high correlations between violation of system of a hemostasis on the 3rd day and systemic complications development, as well as high direct correlation between increase in level of the general homocysteine and systemic complications development rS=0.77, p1=0.001.Conclusions: Hemostasis disorders and the level of general homocysteine correlated with volume of pancreas and retroperitoneal cellular tissue affection and system complications development at the 1-th phase of severe acute pancreatitis.ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅. ΠΡΡΡΡΠΉ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΎΡΠ³Π°Π½ΠΎΠ² Π±ΡΡΡΠ½ΠΎΠΉ ΠΏΠΎΠ»ΠΎΡΡΠΈ. Π ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° Π²Π°ΠΆΠ½ΡΡ ΡΠΎΠ»Ρ ΠΈΠ³ΡΠ°Π΅Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΡΡΠΈΠΏΡΠΈΠ½ΠΎΠ²ΠΎΠΉ Π°ΡΡΠΎΠ°Π³ΡΠ΅ΡΡΠΈΠΈ, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°ΡΡΠ΅ΠΉ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π³Π΅ΠΌΠΎΡΡΠ°Π·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° ΠΊΠ°ΠΊ ΠΌΠ°ΡΠΊΠ΅ΡΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ ΠΏΡΠΈ ΠΎΡΡΡΠΎΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ΅ ΠΈ ΠΈΡ
Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΡΡΠΆΠ΅Π»ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ I ΡΠ°Π·Ρ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅ΡΡΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ. ΠΡΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ ~40% Π»Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ².Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΠ·ΡΡΠΈΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π° Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΡΡΠΎΠ²Π½Ρ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° ΠΊΠ°ΠΊ ΠΌΠ°ΡΠΊΠ΅ΡΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΡΡΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠΎΠΌ Π² ΡΠ°Π½Π½ΠΈΠ΅ ΡΡΠΎΠΊΠΈ ΠΎΡ Π½Π°ΡΠ°Π»Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΡΠΆΠ΅ΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΏΠΎΠ΄ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ.ΠΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 127 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠ΅ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π³ΡΡΠΏΠΏΡ Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈ Π½Π΅ΡΡΠΆΠ΅Π»ΡΠΌ ΠΎΡΡΡΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠΎΠΌ. ΠΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π°: Π°ΠΊΡΠΈΠ²ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΡΠ°ΡΡΠΈΡΠ½ΠΎΠ΅ ΡΡΠΎΠΌΠ±ΠΎΠΏΠ»Π°ΡΡΠΈΠ½ΠΎΠ²ΠΎΠ΅ Π²ΡΠ΅ΠΌΡ, ΠΏΡΠΎΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠ²ΠΎΠ΅ Π²ΡΠ΅ΠΌΡ, ΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠ²ΠΎΠ΅ Π²ΡΠ΅ΠΌΡ, ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ΅ Π½ΠΎΡΠΌΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΈ ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ³Π΅Π½, Π° ΡΠ°ΠΊΠΆΠ΅ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π° Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΡΡΠΎΠ²Π½Ρ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° ΠΎΡΠΌΠ΅ΡΠ°ΡΡΡΡ Π½Π° ΡΡΠ΅ΡΡΠΈ ΡΡΡΠΊΠΈ ΠΎΡ Π½Π°ΡΠ°Π»Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠ° ΡΠ΅Π΄ΡΠΌΡΠ΅ ΡΡΡΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΎΡΡΡΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠΎΠΌ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π»Π°ΡΡ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π° Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π°, ΠΎΠ΄Π½Π°ΠΊΠΎ Π³ΠΈΠΏΠΎΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΎΠ½Π½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π½Π΅ Π±ΡΠ»ΠΎ. Π‘ΡΡΠ΅ΡΡΠ²ΡΡΡ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠ²ΡΠ·ΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΈ ΡΡΠ΅Π΄Π½Π΅ΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΠΎΠ±ΡΠ΅ΠΌΠΎΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π° ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡΡ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° Π½Π° ΡΡΠ΅ΡΡΠΈ ΡΡΡΠΊΠΈ ΠΈ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° (rS=0,94; p1=0,001). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠΎΠΌ Π² 69,57% ΡΠ»ΡΡΠ°Π΅Π² Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ ΡΠΈΡΡΠ΅ΠΌΠ½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ°Π·Π½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ. Π‘ΡΡΠ΅ΡΡΠ²ΡΡΡ ΡΡΠ΅Π΄Π½ΠΈΠ΅ ΠΈ Π²ΡΡΠΎΠΊΠΈΠ΅ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ ΠΌΠ΅ΠΆΠ΄Ρ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° Π½Π° ΡΡΠ΅ΡΡΠΈ ΡΡΡΠΊΠΈ ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΡΠΈΡΡΠ΅ΠΌΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ Π²ΡΡΠΎΠΊΠ°Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½Π°Ρ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΡΠΈΡΡΠ΅ΠΌΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (rS=0,77; p1=0,001).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ΅ΠΌΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΈ ΡΡΠΎΠ²Π΅Π½Ρ ΠΎΠ±ΡΠ΅Π³ΠΎ Π³ΠΎΠΌΠΎΡΠΈΡΡΠ΅ΠΈΠ½Π° ΠΊΠΎΡΡΠ΅Π»ΠΈΡΡΠ΅Ρ Ρ ΠΎΠ±ΡΠ΅ΠΌΠΎΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΏΠΎΠ΄ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΡΡΠΆΠ΅Π»ΡΡ
ΡΠΈΡΡΠ΅ΠΌΠ½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ I ΡΠ°Π·Ρ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ°
Π£Π ΠΠΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ ΠΠΠ Π£Π¨ΠΠΠΠ― Π ΠΠΠ§ΠΠΠ₯ ΠΠ Π ΠΠΠΠΠ ΠΠΠΠΠΠ ΠΠΠ
This paper presents experience in monitoring renal ultrasound data in patients with pancreatonecrosis from 20 to 60 years. It is also present two clinical cases of renal urodynamics in destructive forms of acute pancreatitis. Edematous form of acute pancreatitis and pancreatic cause violations not only secretion but also excretory function of the nephros. In patients with pancreatic necrosis accompanied by the formation of zones of limited fluid in the retroperitoneal space including retroperitoneal phlegmon may occur ureteral compression which is accompanied by appearance of urodynamic disorders in the nephros of varying severity. Ultrasound monitoring of renal care for patients with edematous form of acute pancreatitis, pancreatic necrosis helps to diagnose renal urodynamic disorders which allows timely corrected in the early stages of treatment activities in these patients and improve outcomes.ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΎΠΏΡΡ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΏΠΎΡΠ΅ΠΊ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ 20β60 Π»Π΅Ρ. ΠΡΠΈΠ²Π΅Π΄Π΅Π½ΠΎ 2 ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΈΠΌΠ΅ΡΠ° Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΠΏΡΠΈ Π΄Π΅ΡΡΡΡΠΊΡΠΈΠ²Π½ΡΡ
ΡΠΎΡΠΌΠ°Ρ
ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ°. Π‘Π΄Π΅Π»Π°Π½Ρ Π²ΡΠ²ΠΎΠ΄Ρ ΠΎ ΡΠΎΠΌ, ΡΡΠΎ ΠΎΡΠ΅ΡΠ½Π°Ρ ΡΠΎΡΠΌΠ° ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° ΠΈ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ· ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΡΠ΅ΠΊΡΠ΅ΡΠΎΡΠ½ΠΎΠΉ, Π½ΠΎ ΠΈ ΡΠΊΡΠΊΡΠ΅ΡΠΎΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠΎΡΠ΅ΠΊ. ΠΡΠΈ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π΅, ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°ΡΡΠ΅ΠΌΡΡ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π½ΡΡ
ΠΆΠΈΠ΄ΠΊΠΎΡΡΠ½ΡΡ
Π·ΠΎΠ½ Π² Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠΌ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅, Π² Ρ.Ρ. ΠΏΡΠΈ ΡΠ»Π΅Π³ΠΌΠΎΠ½Π°Ρ
Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π°, ΠΌΠΎΠΆΠ΅Ρ Π²ΠΎΠ·Π½ΠΈΠΊΠ°ΡΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΠ΅ ΠΌΠΎΡΠ΅ΡΠΎΡΠ½ΠΈΠΊΠΎΠ², ΡΡΠΎ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π΅ΡΡΡ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π² ΠΏΠΎΡΠΊΠ°Ρ
ΡΠ°Π·Π½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ. Π£Π»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠΉ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠΎΡΠ΅ΠΊ ΠΏΡΠΈ Π²Π΅Π΄Π΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ°, ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°ΡΡ ΠΏΠΎΡΠ΅ΡΠ½ΡΠ΅ ΡΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ, ΡΡΠΎ Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΠ²ΠΎΠ΅Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΠΊΠΎΡΡΠΈΠ³ΠΈΡΠΎΠ²Π°ΡΡ Π»Π΅ΡΠ΅Π±Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΡ Ρ ΡΡΠΎΠΉ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈ ΡΠ»ΡΡΡΠΈΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ.
ΠΠΠΠΠΠΠ‘Π’ΠΠ§ΠΠ‘ΠΠΠ― Π¦ΠΠΠΠΠ‘Π’Π¬ ΠΠΠ’ΠΠΠ ΠΠΠ¬ΠΠ«Π₯ Π¨ΠΠΠ Π ΠΠ¦ΠΠΠΠ Π‘Π’ΠΠΠΠΠ Π’Π―ΠΠΠ‘Π’Π ΠΠ‘Π’Π ΠΠΠ ΠΠΠΠΠ ΠΠΠ’ΠΠ’Π Π Π‘ΠΠ‘Π’ΠΠ―ΠΠΠ― ΠΠΠΠ¬ΠΠΠΠ
Objective: The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems TolstoyβKrasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. Methods: 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical examination, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by TolstoyβKrasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patientβs general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (ΠΡ), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: Most valuables score for estimation of acute pancreatitisβs severity is BISAP (Se β 98,10%), for estimation of organ failure β MODS 2, (Sp β 100%, PPV β 100%) and APACHE II (Sp β 100% PPV β 100%), for detection of pancreatonecrosis sings β CTSI (Sp β 100%, NPV β 100%), for estimation of need for intensive careΒ β MODS 2, (Sp β 100%, PPV β 100%, NPV β 96,29%) and APACHE II (Sp β 100%, PPV β 100%, NPVΒ β 97,21%), for prediction of lethality β MODS 2, (Se β 100% Sp β 98,14%, NPVΒ β 100%) and APACHE II (Se β 95,00%, NPV β 99,86%). Conclusion: Most effective scores for estimation of acute pancreatitisβs severity are Score of estimation by TolstoyβKrasnogorov, Ranson, Glasgow and BISAP. Scoring systems MODS 2, APACHE II high specificity and positive predictive value allow using it at clinical practice.Β Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΎΡΠ΅Π½ΠΈΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅Π½Π½ΠΎΡΡΡ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ Π½Π΅ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΊΠ°Π» Π’ΠΎΠ»ΡΡΠΎΠ³ΠΎβΠΡΠ°ΡΠ½ΠΎΠ³ΠΎΡΠΎΠ²Π°, Ranson, BISAP, Glasgow, MODS 2, APACHE II ΠΈ CTSI, ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΠΌΡΡ
Π² ΡΡΠ³Π΅Π½ΡΠ½ΠΎΠΉ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠΆΠ΅ΡΡΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° ΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ. ΠΠ΅ΡΠΎΠ΄Ρ: ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 1550 ΠΈΡΡΠΎΡΠΈΠΉ Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π½Π°Ρ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
ΡΡ Π½Π° ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π² ΠΠΎΡΠΎΠΆΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΠ΅ Π½Π° ΡΡΠ°Π½ΡΠΈΠΈ ΠΡΠ°ΡΠ½ΠΎΡΡΡΠΊ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ 2009β2013 Π³Π³. ΠΠΈΠ°Π³Π½ΠΎΠ· ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° ΠΈ Π΅Π³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°Π»ΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ
Π°Π½Π°ΠΌΠ½Π΅Π·Π°, ΠΎΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°Π½Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ. ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΡΠΆΠ΅ΡΡΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° ΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ Π½Π΅ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠΊΠ°Π»Ρ. ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΠΌΡΡ
ΡΠΊΠ°Π» ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΠΏΠΎ ΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ°ΠΌ: ΡΠΎΡΠ½ΠΎΡΡΡ (ΠΡ), ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ (Se), ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ (Sp), ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ (PPV) ΠΈ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² (NPV). Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ: Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠΆΠ΅ΡΡΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ° Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ΅Π½Π½Π°Ρ ΡΠΊΠ°Π»Π° BISAP (Se β 98,10%), Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈΒ β MODS 2, (Sp β 100%, PPV β 100%) ΠΈ APACHE II (Sp β 100% PPV β 100%), Π΄Π»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π° β CTSI (Sp β 100%, NPV β 100%), ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΠΈ Π² ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ β MODS 2, (Sp β 100%, PPV β 100%, NPV β 96,29%) ΠΈ APACHE II (Sp β 100%, PPV β 100%, NPV β 97,21%), Π΄Π»Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ βMODS 2, (Se β 100% Sp β 98,14%, NPV β 100%) ΠΈ APACHE II (Se β 95,00%, NPV β 99,86%). ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: ΠΊ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌΠΈ ΡΠΊΠ°Π»Π°ΠΌ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΠΌ ΠΎΡΠ΅Π½ΠΈΡΡ ΡΡΠ΅ΠΏΠ΅Π½Ρ ΡΡΠΆΠ΅ΡΡΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ°, ΠΌΠΎΠΆΠ½ΠΎ ΠΎΡΠ½Π΅ΡΡΠΈ ΡΠΊΠ°Π»Ρ Π’ΠΎΠ»ΡΡΠΎΠ³ΠΎβΠΡΠ°ΡΠ½ΠΎΠ³ΠΎΡΠΎΠ²Π°, Ranson, Glasgow ΠΈ BISAP. ΠΡΡΠΎΠΊΠ°Ρ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ° Π΄Π»Ρ ΡΠΊΠ°Π» MODS 2, APACHE II ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΡ
ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅.