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1.
Severe acute pancreatitis: Clinical course and management   总被引:28,自引:0,他引:28  
Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.  相似文献
2.
AIM: To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-κB expression in multiple organs of SAP rats as well as the mechanisms involved.
METHODS: Ninety Sprague-Dawley (SD) rats with SAP were randomly divided into the model group (n = 45) and dexamethasone treatment group (n = 45), and another 45 rats were selected for the sham operation group. All groups were randomly subdivided into the 3 h, 6 h and 12 h groups, each group containing 15 rats. The survival of all groups and pathological changes of multiple organs (liver, kidney and lung) were observed at different time points after the operation. The pathological score of multiple organs was carried out, followed by the determination of amylase, endotoxin and TNF-α contents in blood. The tissue microarray was used to detect the expression levels of NF-κB p65 protein in multiple organs. RESULTS: There was no marked difference between the model group and treatment group in the survival rate. The amylase content,of the treatment group was significantly lower compared to the model group at 12 h (P 〈 0.01, 7791.00 vs 9195.00). Moreover, the endotoxin and TNF-α levels of the treatment group were significantly lower than that of the model group at 6 h and 12 h (P 〈 0.01, 0.040 vs 0.055, 0.042 vs 0.059 and P 〈 0.05, 58.30 vs 77.54, 38.70 vs 67.30, respectively). Regarding the changes in liver NF-κB expression, the model group significantly exceeded the sham operation group at 3 h (P 〈 0.01, 1.00 vs 0.00), and the treatment group significantly exceeded the sham operation group at 12 h (P 〈 0.01, 1.00 vs 0.00), whereas no marked difference was observed between the model group and treatment group at all time points. The kidney NF-κB expression level in the treatment group significantly exceeded the model group (P 〈 0.05, 2.00 vs 0.00) and the sham operation group (P 〈 0.01, 2  相似文献
3.
AIM: To compare the benefi cial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP).METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE Ⅱ score, Balthazar’s CT score and CRP were assessed daily during the study period.RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE Ⅱ normalization (APACHE Ⅱ score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05).CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy.  相似文献
4.
急性胰腺炎大鼠肺组织中水通道蛋白-1的表达及功能   总被引:11,自引:0,他引:11  
目的:研究水通道蛋白-1(AQP-1)在急性胰腺炎大鼠肺组织中的表达及其功能,探讨其表达与肺损伤的关系.方法:将Wistar大鼠分为假手术组(n=24)、肺损伤组(n=24)、地塞米松治疗组(n=24).采用逆行胰胆管注射15 g/L去氧胆酸诱发大鼠急性胰腺炎肺损伤模型,地塞米松组于造模后立即于尾静脉注射地塞米松2 mg/kg.每组分别于造模后4,8,12 h剖杀,取血及肺组织.通过检测血淀粉酶、血气、肺干/湿比值和肺组织病理切片判断胰腺炎及肺损伤的严重程度,放免法测血清TNF-α水平,RT-PCR检测肺组织AQP-1 mRNA的表达,免疫组化法检测肺组织AQP-1的表达.结果:与假手术组相比,胰腺炎肺损伤组血清淀粉酶、肺干/湿比值、TNF-α、肺组织病理损害程度明显升高,血氧、AQP-1mRNA(4 h:0.403±0.018 vs 0.794±0.015,P<0.01;8 h:0.382±0.025 vs 0.812±0.032,P<0.01;12 h:0.361±0.016 vs 198±5,P<0.01)和AQP-1蛋白(4 h:104±4 vs 193±8,P<0.01;8 h:96±5 vs 201±7,P<0.01;12 h:94±3 vs198±5,P<0.01)表达显著下调.与肺损伤组相比,地塞米松组血清淀粉酶、TNF-α、肺干/湿比值、肺组织病理损害程度明显降低,血氧、AQP-1 mRNA(4 h:0.681±0.031 vs 0.403±0.018,P<0.05;8 h:0.763±0.013 vs 0.382±0.025,P<0.05;12 h:0.784±0.032 vs 0.361±0.016,P<0.05)和AQP-1的蛋白(4 h:145±6 vs104±4,P<0.05;8 h:152±8 vs 96±5,P<0.05;12 h:154±4 vs 94±3,P<0.05)表达则明显升高,且与TNF-α的水平呈负相关性.结论:水通道蛋白-1表达与急性胰腺炎的肺损伤密切相关,其表达可能与TNF-α有关,地塞米松可上调其表达而减轻肺水肿.  相似文献
5.
AIM: To observe the therapeutic efficacy of Baicalin in rats with severe acute pancreatitis (SAP) and explore its therapeutic mechanisms. METHODS: The SAP rat models were randomly divided into the model control group, Baicalin treatment group, octreotide treatment group and sham operation group. All groups were randomly subdivided into 3 h, 6 h and 12 h groups with 15 rats in each group. The survival, ascites volume and pathological changes of pancreas in all rats were observed at different time points after operation. The plasma amylase content and serum TNF-α, IL-6, malonaldehyde (MDA) and PLA2 contents were also determined. RESULTS: The survival was not obviously different between the treated groups, and was significantly higher in treated groups at 12 h compared to the model control group (P 〈 0.05, 15 vs 10). The ascites/body weight ratio at 3 h and 6 h was significantly lower in Baicalin treatment group compared to the model control group and octreotide treatment group (P 〈 0.05, 1.00 vs 2.02 and 1.43 and P 〈 0.001, 2.29 (1.21) vs 2.70 (0.80) and 2.08 (2.21), respectively). The contents of amylase, TNF-α, IL-6, MDA and PLA2 were significantly lower in the treated groups than in the model control group (P 〈 0.05, 4342 vs 5303, 5058 vs 6272 in amylase, P 〈 0.01, 21.90 vs 36.30, 23.80 vs 39.70, 36 vs 54.35 in MDA and 56.25 vs 76.10 in PIA2, or P 〈 0.001, 65.10 and 47.60 vs 92.15 in TNF-α, 3.03 vs 5.44, 2.88 vs 6.82, 2.83 vs 5.36 in IL-6, respectively). The pathological scores of pancreas in the treated groups were significantly lower than that in the model control group (P 〈 0.05, 9.00 vs 10.05, 6.00 vs 9.00, 8.00 vs 10.05), but no marked difference was found between the treated groups. CONCLUSION: The Baicalin injection has significant therapeutic effects on SAP rats, its effects are similar to those of octreotide. The Baicalin injection is also cheap and has a big application range, quite hopefully to be used in clinical treatment of SAP.  相似文献
6.
AIM: To evaluate the effectiveness and safety of early nasogastric enteral nutrition (NGEN) for patients with severe acute pancreatitis (SAP). METHODS: We searched Cochrane Central Register of Controlled Trials (Issue 2, 2006), Pub-Medline (1966-2006), and references from relevant articles. We included randomized controlled trials (RCTs) only, which reported the mortality of SAP patients at least. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration’s RevMan 4.2.9 software was used for statistical analysis. RESULTS: Three RCTs were included, involving 131 patients. The baselines of each trial were comparable. Meta-analysis showed no significant differences in mortality rate of SAP patients between nasogastric and conventional routes (RR = 0.76, 95% CI = 0.37 and 1.55, P = 0.45), and in other outcomes, including time of hospital stay (weighted mean difference = -5.87, 95% CI = -20.58 and 8.84, P = 0.43), complication rate of infection (RR = 1.41, 95% CI = 0.62 and 3.23, P = 0.41) or multiple organ defi ciency syndrome (RR = 0.97, 95% CI = 0.27 and 3.47, P = 0.97), rate of admission to ICU (RR = 1.00, 95% CI = 0.48 and 2.09, P = 0.99) or conversion to surgery (RR = 0.66, 95% CI = 0.12 and 3.69, P = 0.64), as well as recurrence of re-feeding pain and adverse events associated with nutrition. CONCLUSION: Early NGEN is a breakthrough in the management of SAP. Based on current studies, early NGEN appears effective and safe. Since the available evidence is poor in quantity, it is hard to make an accurate evaluation of the role of early NGEN in SAP.Before recommendation to clinical practice, further high qualified, large scale, randomized controlled trials are needed.  相似文献
7.
AIM: To investigate the influence of high dose of dexamethasone on inflammatory mediators and apoptosis of rats with severe acute pancreatitis (SAP).
METHODS: SAP rats were randomly assigned to the model group and treatment group while the normal rats were assigned to the sham operation group. The mortality, ascite volumes, ascites/body weight ratio and pancreas pathological changes of all rats were observed at 3, 6 and 12 h after operation. Their contents of amylase and endotoxin in plasma and contents of tumor necrosis factor (TNF-α), phospholipase A2 (PLA2) and IL-6 in serum were also determined. The microarray sections of their pancreatic tissues were prepared, terminal transferase dUTP nick end labeling (TUNEL) staining was performed and apoptotic indexes were calculated.
RESULTS: There was no marked difference between treatment group and model group in survival. The contents of amylase and endotoxin in plasma and contents of TNF-α, PLA2 and IL-6 in serum, ascite volumes, ascites/body weight ratio and pancreas pathological scores were all lower in treatment group than in model group to different extents at different time points [P 〈 0.05, 58.3 (26.4) ng/L vs 77.535 (42.157) ng/L in TNF-α content, 8.00 (2.00) points vs 9.00 (2.00) points in pathological score of pancreas respectively; P 〈 0.01, 0.042 (0.018) EU/mL vs 0.056 (0.0195) EU/mL in endotoxin content, 7791 (1863) U/L vs 9195 (1298) U/L in plasma amylase content, 1.53 (0.79) vs 2.38 (1.10) in ascites/body weight ratio, 8.00 (1.00) points vs 11.00 (1.50) points in pathological score of pancreas; P 〈 0.001, 3.36 (1.56) ng/L vs 5.65 (1.08) ng/L in IL-6 content, 4.50 (2.00) vs 7.20 (2.00), 4.20 (1.60) vs 6.40 (2.30), 3.40 (2.70) vs 7.90 (1.70) in ascite volumes, respectively]. The apoptotic indexes of pancreas head and pancreas tail were all higher in treatment group than in model group at 6 h [P 〈 0.01, 0.00 (2.00)% vs 0.00 (0.00)%,  相似文献
8.
早期肠内营养联合肠屏障保护剂治疗急性重症胰腺炎64例   总被引:9,自引:2,他引:7  
目的:探讨早期肠内营养联合肠屏障保护剂在急性重症胰腺炎治疗中的应用价值.方法:将64例SAP患者随机分三组,A组予常规治疗,B组在常规治疗基础上通过鼻空肠管给予早期肠内营养,C组通过鼻空肠管给予早期肠内营养并加用肠屏障保护剂.观察患者症状、体征、WBC、CRP、血淀粉酶恢复正常时间,其体质量及血清白蛋白变化情况以及对比其总住院费用、平均每天的住院费用及住院时间.结果:B组在症状、体症、WBC、CRP、血淀粉酶恢复时间以及住院时间、住院费用均明显优于A组(P<0.05).C组在CRP及白细胞数恢复时间上更是优于B组,但平均每天住院费用三组没有明显差异性(P>0.05).结论:在SAP治疗中应用鼻空肠管进行早期肠内营养联合肠屏障保护剂,可以改善SAP患者的营养状况,加快症状恢复,缩短病程,减少医疗费用.  相似文献
9.
AIM: To determine the effect of pioglitazone, a specific peroxisome proliferator-activated receptor-γ, (PPARγ) ligand, on development of severe acute pancreatitis (SAP) and expression of nuclear factor-kappa B (NF-κB) and intercellular adhesion molecule-1 (ICAM-1) in the pancreas. METHODS: Male Sprague-Dawley (SD) rats (160-200 g) were randomly allocated into three groups (n = 18 in each group): severe acute pancreatitis group, pioglitazone group, sham group. SAP was induced by retrograde infusion of 1 mL/kg body weight 5% sodium taurocholate (STC) into the biliopancreatic duct of male SD rats. Pioglitazone was injected intraperitoneally two hours piror to STC infusion. Blood and ascites were obtained for detecting amylase and ascitic capacity. Pancreatic wet/dry weight ratio, expression of NF-κB and ICAM-1 in pancreatic tissues were detected by immunohistochemical staining. Pancreatic tissue samples were stained with hematoxylin and eosin (HE) for routine optic microscopy. RESULTS: Sham group displayed normal pancreatic structure. SAP group showed diffuse hemorrhage, necrosis and severe edema in focal areas of pancreas. There was obvious adipo-saponification in abdominal cavity. Characteristics such as pancreatic hemorrhage, necrosis, severe edema and adipo-saponification were found in pioglitazone group, but the levels of those injuries were lower in pioglitazone group than those in SAP group. The wet/dry pancreatic weight ratio, ascetic capacity, serum and ascitic activities of anylase in the SAP group were significantly higher than those in the sham group and pioglitazone group respectively (6969.50 ± 1368.99 vs 2104.67 ± 377.16, 3.99 ± 1.22 vs 2.48 ± 0.74, P 〈 0.01 or P 〈 0.05). According to Kusske criteria, the pancreatic histologic score showed that interstitial edema, inflammatory infiltration, parenchyma necrosis and parenchyma hommorrhage in SAP group significantly differed from those in the sham group and pioglitazone group (7.17 ± 1.83 vs  相似文献
10.
中药治疗重症急性胰腺炎的规律   总被引:7,自引:0,他引:7  
目的:总结中药复方治疗重症急性胰腺炎(SAP)的用药经验和特点,探讨其用药规律,并评价其疗效.方法:收集1970-2006年核心期刊中治疗重症急性胰腺炎的临床研究文献,共入选复方83首,再对出现频率较高的中药进行分析;通过总结有效率及疗效评价指标等探讨中医药治疗SAP现状.结果:目前治疗SAP以泻下、理气、清热、活血为主.应用最多的是大黄,应用频率达到100%.中医药在治疗重症胰腺炎方面,效果是肯定的,平均有效率89.12%;固定方剂鼻饲为主,随证加减占39.66%;平均疗程8.7d;治疗效果以症状改善为主.结论:泻下法是治疗重症急性胰腺炎的主要方法,理气、清热、活血常与其联合应用.中药治疗SAP效果肯定,但需规范化.  相似文献
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