The Correlative Study Between Severe Acute Pancreatitis Associated Ascitic Fluids And APACHE Ⅱ Score

Objective Through observation drainage on day1,3,5,7the concentration ofascites and serum tumor necrosis factor-alpha, interleukin-6, amylase and the amountof ascites, APACHE II score.To study the correlative between severe acutepancreatitis associated ascitic fluids tumor necrosis factor-alpha, interleukin-6(IL-6),amylase,the amount of ascites with APACHE II score, analyze hospital stay, theincidence of short-term complications and mortality,the aim is to provideexperimental evidence for assessment the severity of SAP.Methods54patients with severe acute pancreatitis associated ascitic fluids accordto the2007Chinese Medical Association of Gastroenterology will pancreatic diseasestudy group developed acute pancreatitis Guide that were admitted from HunanProvincial People’s Hospital ICU，from May2011to October2012.54patients wereaccording to the admission APACHE II score will be divided into two groups(APACHE II score <20is divided into A group n=28,APACHE II score≥20isdivided into B group n=26), First day of admission all patients underwent bedsideB-ultrasound positioning abdominal puncture catheter drainage of ascites,drainage onday1,3,5,7collected ascites and serum, detection the concentration of ascites andserum TNF-alpha, IL-6, amylase, collect the amount of ascites, APACHE II score,hospital stay,the incidence of short-term complications and mortality for statisticalanalysis, and analyze the correlative between ascites that the concentration ofTNF-alpha, IL-6, amylase, the amount of ascites and APACHE II score.Results (1) Drainage on day1,3,5,7, the group B concentration of ascites and serumTNF-alpha, IL-6comparison A group were significantly differences (P <0.01); theconcentration of ascites TNF-alpha,IL-6was significantly higher than theconcentration of serum (P=0.000);drainage on day1the concentration of ascites andserum TNF-alpha increased up to the peak, drainage on day1the concentration of ascites and serum IL-6increased up to the peak, with the condition graduallyimproved after drainage, APACHE Ⅱ score gradually decreased, the concentrationof ascites and serum TNF-alpha, IL-6were gradually decreased.(2).(3) the B groupconcentration of ascites amylase, the amount of ascites higher than the A groupwere significant difference (ascites amylase6354.7±1213.4VS4141.5±1015.5U/L, P=0.009; the amount of ascites778.8±165.5vs1400.6±215.8ml, P=0.000),the A group drainage on1,3,5,7d the concentration of serum AMY and drainage on3,5,7d the concentration of ascites AMY, the amount of ascites comparison with Bgroup were not statistically significant (P≥0.05),with the condition improved,APACHE Ⅱ score gradually decreased, the concentration of ascites and serumAMY, the amount of ascites gradually decreased.(4) Comparison the concentrationof ascites TNF-alpha, IL-6, amylase, the amount of ascites with APACHE II scorewas a positive correlation (ascites TNF-alpha and APACHE II score correlationcoefficient r=0.646, P=0.000; IL-6and APACHE II score correlation coefficient r=0.761, P=0.000; ascites amylase and APACHE II score correlation coefficient r=0.742, P=0.000; the amount of ascites and APACHE II score The correlationcoefficient r=0.798, P=0.000);comparison the concentration of ascitesTNF-alpha,IL-6with the concentration of serum has a positive correlation(correlation coefficients were r=0.828, P=0.000; r=0.866, P=0.000);APACHEIIscore and ascites IL-6, the ascites of TNF-a, serum TNF-a serum IL-6, ascitesamylase, the amount of ascites create a multiple linear regression analysis showedthat non-standardized the size of the regression coefficients were ascites TNF-alpha，ascites IL-6, serum TNF-a, serum IL-6,ascites amylase, the amount of ascites.(5) Bgroup of patients hospital stay, the incidence of systemic complications,mortalitycompared with A group were significantly difference (hospital stay26.7±11.8vs15.1±6.3days, P=0.001; ARDS21（80.8%）vs9（32.1%）,ARF15（67.7%）vs3（10.7%）,AHF12(46.2%) vs3（10.7%）,ALF5（19.2%）vs1（3.6%）,DIC3（11.5%）vs0,PE2（7.7%）vs0；mortality rate of11.5%vs0, P=0.000)Conclusions (1) Group B patients with SAP the concentration of ascites TNF-alpha,IL-6, AMY and the amount of ascites was significantly higher than group A, the hospital stay, the incidence of short-term complications and mortality was also higherthan in group A; and the concentration of ascites TNF-alpha, IL-6，AMY and theamount of ascites and APACHE II score was positively correlated, suggesting thatdetection the pancreatitis associated ascitic fluid could be used to assessment theseverity and prognosis of SAP;(2) the concentration of ascites TNF-alpha, IL-6higher than serum TNF-alpha, IL-6,that was positively correlated; Afterdrainage1,3,5,7d the concentration of ascites and serum in TNF-alpha, IL-6the AMYand amount of ascites, APACHE II score decreased, ptompted that clinical drainage ofpancreatitis associated ascitic fluid may be comprehensively treatmented to improvethe prognosis of SAP.