大黄甘草汤联合间断短时静脉-静脉血液滤过对重症急性胰腺炎患者细胞因子的影响

Objective To approach the treatment effect and mechanism of action of intermittent short time veno-venuous hemofiltration(ISVVH)and Rheum Glycyrrhiza Decoction in patients with severe acute pancreatitis(SAP).Methods One hundred and three SAP patients were randomly divided into 3 groups.Rheum Glyeyrrhiza uraleusis fisch Decoction group(A,n=25),ISVVH group(B,n=35)and ISVVH CO-Rheum Glyeyrrhiza uralensis fisch decoction group(C,n=43).A,B and C groups were all treated with conventional therapy.However.the patients in group A were added Rheum Glycyrrhiza uralensis fisch Decoction,the patients in group B added ISVVH while group C were raised ISVVH co-Rheum Glycyrrhiza uralensis fiach Decoction.Finally,we observed three groups of patients with heart rate(HR),respiration(R),blood pressure(BP),liver and kidney function;oxygenation index(PaO2/FiO2),oxygen saturation(SaO2);blood routine,plasma electrolytes,glucose and C-reactive protein;parallel APACHE Ⅱ score;measure level of TNF-α,IL-10 in patients blood serum when they were admitted to hospital,24,48,96 h after treatment respectively.Results After treated 24,48,96 h,C group compared to B group,B group compared to A group,there were significantly improvements in APACHE Ⅱ score(P < 0.05);TNF-alevel decreased(P < 0.05);IL-10 level increased(P < 0.05);three groups after treatment of acute lung injury, thoracic/abdominal effusion,intestinal paralysis/obstruction,sepsis and other complications improved significantly(P < 0.05).Conclusions ISVVH and glycyrrhiza decoction can regulate the liver and renal dysfunctions that followed SAP,raise physical conditions,improve the complications of patients with SAP.     

大黄甘草汤联合间断短时静脉-静脉血液滤过对重症急性胰腺炎患者细胞因子的影响

Objective To approach the treatment effect and mechanism of action of intermittent short time veno-venuous hemofiltration(ISVVH)and Rheum Glycyrrhiza Decoction in patients with severe acute pancreatitis(SAP).Methods One hundred and three SAP patients were randomly divided into 3 groups.Rheum Glyeyrrhiza uraleusis fisch Decoction group(A,n=25),ISVVH group(B,n=35)and ISVVH CO-Rheum Glyeyrrhiza uralensis fisch decoction group(C,n=43).A,B and C groups were all treated with conventional therapy.However.the patients in group A were added Rheum Glycyrrhiza uralensis fisch Decoction,the patients in group B added ISVVH while group C were raised ISVVH co-Rheum Glycyrrhiza uralensis fiach Decoction.Finally,we observed three groups of patients with heart rate(HR),respiration(R),blood pressure(BP),liver and kidney function;oxygenation index(PaO2/FiO2),oxygen saturation(SaO2);blood routine,plasma electrolytes,glucose and C-reactive protein;parallel APACHE Ⅱ score;measure level of TNF-α,IL-10 in patients blood serum when they were admitted to hospital,24,48,96 h after treatment respectively.Results After treated 24,48,96 h,C group compared to B group,B group compared to A group,there were significantly improvements in APACHE Ⅱ score(P < 0.05);TNF-alevel decreased(P < 0.05);IL-10 level increased(P < 0.05);three groups after treatment of acute lung injury, thoracic/abdominal effusion,intestinal paralysis/obstruction,sepsis and other complications improved significantly(P < 0.05).Conclusions ISVVH and glycyrrhiza decoction can regulate the liver and renal dysfunctions that followed SAP,raise physical conditions,improve the complications of patients with SAP.     

大黄辅助早期肠内营养对急性坏死性胰腺炎病程影响的研究

Objective To investigate the effect of rhubarb assisted early enteral nutrition (EEN) on acute necrotizing pancreatitis(ANP) in rats. Methods A total of 48 Wistar rats were ran-domized into 4 groups(n=12) including ANP group (group A), rhubarb group (group B), EEN group (group C) and rhubarb assisted EEN (RAEEN) group (group D). The rats in group B, C and D were infused with rhubarb, enteral nutrient solution and enteral nutrient solution plus rhubarb by enteral nutrient canal after establishing the model, respectively. The remaining living animals in each group were sacrificed 48 hours after ANP models were developed to determine the tumor necrosis fac-tor-alpha (TNF-α), endotoxin, D-lactate, maleic dialdehyde (MDA), angiotensin Ⅱ (Ang Ⅱ) in ser-um. The intestinal secretory IgA (SIgA), the amount of ascitic fluid and the wet-dry weight ratio of ileum, the pancreatic Myeloperoxidase (MPO) activity as well as the wet-dry weight ratio of pancreas were determined and the pathologic changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas. Results Compared with group A, group B, C and D had signifi-cant difference in every index (P<0. 05). Furthermore, compared with rhubarb and EEN, RAEEN significantly increased the level of intestinal SIgA but reduced the other data obviously (P<0. 05). Conclusion Administration of RAEEN can effectively protect the intestinal barrier function, improve the organismic immunity, inhibit the systemic inflammatory reaction and ameliorate the microcirculato-ry disorders in ANP. The combined strategy is more safe and effective than either one alone.     

大黄辅助早期肠内营养对急性坏死性胰腺炎病程影响的研究

Objective To investigate the effect of rhubarb assisted early enteral nutrition (EEN) on acute necrotizing pancreatitis(ANP) in rats. Methods A total of 48 Wistar rats were ran-domized into 4 groups(n=12) including ANP group (group A), rhubarb group (group B), EEN group (group C) and rhubarb assisted EEN (RAEEN) group (group D). The rats in group B, C and D were infused with rhubarb, enteral nutrient solution and enteral nutrient solution plus rhubarb by enteral nutrient canal after establishing the model, respectively. The remaining living animals in each group were sacrificed 48 hours after ANP models were developed to determine the tumor necrosis fac-tor-alpha (TNF-α), endotoxin, D-lactate, maleic dialdehyde (MDA), angiotensin Ⅱ (Ang Ⅱ) in ser-um. The intestinal secretory IgA (SIgA), the amount of ascitic fluid and the wet-dry weight ratio of ileum, the pancreatic Myeloperoxidase (MPO) activity as well as the wet-dry weight ratio of pancreas were determined and the pathologic changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas. Results Compared with group A, group B, C and D had signifi-cant difference in every index (P<0. 05). Furthermore, compared with rhubarb and EEN, RAEEN significantly increased the level of intestinal SIgA but reduced the other data obviously (P<0. 05). Conclusion Administration of RAEEN can effectively protect the intestinal barrier function, improve the organismic immunity, inhibit the systemic inflammatory reaction and ameliorate the microcirculato-ry disorders in ANP. The combined strategy is more safe and effective than either one alone.     

乌药和大黄合用保护重症胰腺炎肠屏障的治疗体会

Objective To observe the effects of Wu-Yao,Da-Huang combination on severe acute pancreatitis gut barrier protection,and on the clinical treatment of severe acute pancreatitis.Methods In the past 10 months,45 casea of severe pancreatitis those treated in our department were randomly divided into 3 groups.group A:on the basis of conventional treatment of inhibiting trypsin secretion and anti-infection,50%magnesium sulfate 50 mL were insected via stomach tube,twice a day;group B:on the basis of conventional treatment,Da-Huang decoction 100 mL high retention enema,twice a day;group C:on the basis of conventional treatment were given by Wu-Yao decoction 50 mL.as well as 100 mL Da-Huang decoction enema,twice a day.Three groups were observed the release of abdominal distension,abdominal(bladder pressure measurement),ACAPHE-Ⅱ score,indicators of neutrophils(N),C-reactive protein(CRP),and the blood levels of D-lactic acid in 1,3,5,7,9 days etc.Results The abdomenal circumference,abdominal pressure,APACHE-Ⅱ score,N and other indicators of the three groups after treatment had the significantly different(P<0.05),with group C the most significant decrease,while no significant difference in CRP.Endotoxin content in three groups was significantly different(P<0.05),and each diminished with time(P<0.05).Conclusion Wu-Yao,Da-Huang combination on gut barrier dysfunction in severe acute pancreatitis showed synergistic protective effect.     

乌药和大黄合用保护重症胰腺炎肠屏障的治疗体会

Objective To observe the effects of Wu-Yao,Da-Huang combination on severe acute pancreatitis gut barrier protection,and on the clinical treatment of severe acute pancreatitis.Methods In the past 10 months,45 casea of severe pancreatitis those treated in our department were randomly divided into 3 groups.group A:on the basis of conventional treatment of inhibiting trypsin secretion and anti-infection,50%magnesium sulfate 50 mL were insected via stomach tube,twice a day;group B:on the basis of conventional treatment,Da-Huang decoction 100 mL high retention enema,twice a day;group C:on the basis of conventional treatment were given by Wu-Yao decoction 50 mL.as well as 100 mL Da-Huang decoction enema,twice a day.Three groups were observed the release of abdominal distension,abdominal(bladder pressure measurement),ACAPHE-Ⅱ score,indicators of neutrophils(N),C-reactive protein(CRP),and the blood levels of D-lactic acid in 1,3,5,7,9 days etc.Results The abdomenal circumference,abdominal pressure,APACHE-Ⅱ score,N and other indicators of the three groups after treatment had the significantly different(P<0.05),with group C the most significant decrease,while no significant difference in CRP.Endotoxin content in three groups was significantly different(P<0.05),and each diminished with time(P<0.05).Conclusion Wu-Yao,Da-Huang combination on gut barrier dysfunction in severe acute pancreatitis showed synergistic protective effect.     

术前介入化疗对胰头癌淋巴结转移的影响

Objective To evaluate the efficacy of preoperative regional intra-arterial chemotherapy (RIAC) in the treatment of resectable pancreatic head carcinoma. Methods The clinical data of 50 patients with resectable pancreatic head carcinoma who had been admitted to the Research Institute of Pancreatic Diseases of Fudan University from December 2006 to July 2007 were retrospectively analyzed. Patients were randomly divided into2 groups (n =25 in each group): patients in group A were treated with preoperative RIAC followed by regional pancreaticoduodenectomy, and patients in group B were treated with surgical procedure routinely. The lymphatic metastases in the 50 specimens of pancreatic head carcinoma were detected by histological examination with hematoxylin and eosin (HE) staining, and lymphatic micrometastases were detected by immunohistochemical method with staining of cytokeratin AE1/AE3 in 10 specimens with negative HE staining of the lymph nodes in each group. Results There was no significant difference in the incidence of complications, the length of hospital stay and the 1-, 2-year survival rates between the 2 groups (χ2 = 0.12, 2.88, P > 0.05). The incidence of positive lymph node metastasis in group A was 7.1% (52/734), which was significantly higher than 22.1% (118/532) in group B (χ2 = 60.01, P < 0.05). The incidence of lymphatic micrometastasis was 9.4% (30/319) in group A, and 9.1% (23/252) in group B, with no statistical difference between the 2 groups (χ2= 0.01, P > 0.05). Conclusions Preoperative RIAC is helpful in improving the prognosis of patients with resectable pancreatic head carcinoma by reducing the incidence of lymphatic metastasis and decreasing tumor stage.     

慢性肾衰竭大鼠肠道通透性及损伤的研究

Objective To observe the histopathologic injury of small intestine and intestinal permeability in chronic renal failure (CRF) rats. Methods Twenty male Sprague-Dawley rats were randomly assigned to CRF group (n=10) and control group (n=10). 5/6 nephrectomy was used to establish CRF rats, while sham operation for control. Blood biochemistry was regularly monitored until CRF model was successfully established. The model rats were fed with lactulose (L) and mannitol (M) through intragastric administration. Urine was collected after 6 hours, and the concentration of lactulose and mannitol in urine was measured using high pressure liquid chromatograph with refractive index detector (HPLC-RID), and the ratio of urinary excretion of L/M was calculated to evaluate intestinal permeability. Small intestinal mucosa were stained by hematoxylin-eosin (HE) and observed with light microscope (villus height, thickness of muscle layer and villus count), histological damage score was used to evaluate intestinal injury. Results The L/M ratio of CRF group was higher than that of control group (1.75±0.11 vs 1.20±0.06, P<0.01). The small intestinal mucosal villus height and thickness of muscle layer in CRF group were higher (P<0.01), and the number of villi was lower compared to control group (P<0.01). The score of histopathologic intestine damage of CRF group was higher than that of control group (1.00±0.71 vs 0, P<0.01). Conclusion The intestinal permeability of CRF rats is increased with varying degrees of intestinal damage.     

慢性肾衰竭大鼠肠道通透性及损伤的研究

Objective To observe the histopathologic injury of small intestine and intestinal permeability in chronic renal failure (CRF) rats. Methods Twenty male Sprague-Dawley rats were randomly assigned to CRF group (n=10) and control group (n=10). 5/6 nephrectomy was used to establish CRF rats, while sham operation for control. Blood biochemistry was regularly monitored until CRF model was successfully established. The model rats were fed with lactulose (L) and mannitol (M) through intragastric administration. Urine was collected after 6 hours, and the concentration of lactulose and mannitol in urine was measured using high pressure liquid chromatograph with refractive index detector (HPLC-RID), and the ratio of urinary excretion of L/M was calculated to evaluate intestinal permeability. Small intestinal mucosa were stained by hematoxylin-eosin (HE) and observed with light microscope (villus height, thickness of muscle layer and villus count), histological damage score was used to evaluate intestinal injury. Results The L/M ratio of CRF group was higher than that of control group (1.75±0.11 vs 1.20±0.06, P<0.01). The small intestinal mucosal villus height and thickness of muscle layer in CRF group were higher (P<0.01), and the number of villi was lower compared to control group (P<0.01). The score of histopathologic intestine damage of CRF group was higher than that of control group (1.00±0.71 vs 0, P<0.01). Conclusion The intestinal permeability of CRF rats is increased with varying degrees of intestinal damage.     

缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

小檗碱对严重腹腔感染时肠屏障功能障碍的防治作用

目的探讨小檗碱对严重腹腔感染导致肠屏障功能障碍的防治作用。 方法制备严重腹腔感染大鼠模型即盲肠结扎+穿孔模型（CLP模型）,将90只SD大鼠随机分为感染组（CLP感染,不予治疗）、对照组（只剖腹而不行CLP术）和治疗组（盐酸小檗碱300mg/kg灌胃给药）,各30只,观察各组肠道病理改变,进行血细菌培养,检测血清内毒素、二胺氧化酶（DAO）水平、D-乳酸含量评估其肠屏障功能;同时检测血清C反应蛋白（CRP）、白介素2（IL-2）、肿瘤坏死因子α（TNF-α）水平等炎症相关因子,了解炎症反应情况。 结果治疗组肠黏膜损伤明显减轻;在术后第1、2、4天检测点上,治疗组血清内毒素、DAO及D-乳酸水平明显低于感染组（P<0.01）。同时治疗组TNF-α、血清CRP及IL-2水平明显低于感染组（P<0.01）。 结论严重腹腔感染时过度炎症反应可导致肠屏障功能障碍,小檗碱通过降低炎症反应而实现对肠屏障功能的保护。     

重症急性胰腺炎早期液体治疗策略的探讨

目的探讨重症急性胰腺炎(SAP)早期两种不同液体治疗策略对患者预后的影响。方法回顾性分析我院2000年1月至2011年11月期间收治的符合入选标准且达到液体治疗目标的97例SAP患者,2000年1月至2004年12月期间收治的患者采用传统的液体治疗方法(简称传统治疗组,n=34),2005年1月至2011年11月期间收治的患者采取的早期目标指导的液体治疗策略(简称早期目标治疗组,n=63),比较2组间急性生理与慢性健康状况Ⅱ评分(APACHEⅡ)、器官功能不全评分(Marshall)、多器官功能障碍综合征(MODS)发生率、胰腺感染率和住院病死率的差异。结果与传统治疗组相比,早期目标治疗组患者液体治疗后第3天时的APACHEⅡ和Marshall评分较传统治疗组明显降低(APACHEⅡ评分:7.38±4.01比11.35±4.27,P=0.011;Marshall评分:4.13±2.06比6.82±3.15,P=0.016)。另外,早期目标治疗组患者入院后7 d内MODS发生率、胰腺感染率和住院病死率也较传统治疗组有所降低(MODS:46.0%比61.8%,P=0.139;胰腺感染率:31.7%比44.1%,P=0.226;住院病死率:15.8%比23.5%,P=0.355),但其差异均无统计学意义。结论本研究有限的病例结果提示,早期目标指导的液体治疗可在一定程度上缓解SAP病情,但能否改善SAP患者预后有待临床进行前瞻性随机对照研究。     

肠内免疫营养对胃癌患者术后肠黏膜屏障功能的影响

目的探讨谷氨酰胺强化早期肠内营养对胃癌患者术后肠黏膜屏障功能的影响及临床疗效。方法将80例行胃癌根治性术加术中腹腔温热化疗的进展期胃癌患者按随机数字表法随机分为试验组（40例．术后行谷氨酰胺强化肠内营养支持）和对照组（40例．行常规肠内营养支持）。分别于术前1d、术后第1、7、12天检测肠黏膜屏障功能指标,包括血清二胺氧化酶（DAO）、内毒素脂多糖（LPS）、TNF-α浓度及尿中乳果糖与甘露醇比值（L／M）,并观察肛门排气时间及接受早期营养的耐受性。结果两组患者一般资料的差异均无统计学意义（均P〉0．05）。试验组和对照组分别有2例（5％）和1例（2．5％）不能耐受肠内营养（P〉0．05）。术后1d,各项肠黏膜屏障功能指标两组差异均无统计学意义（P〉0．05）：术后7d．试验组各项肠黏膜屏障功能指标均显著低于对照组（均P〈0．05）;术后12d,试验组DAO、LPS、TNF-α水平仍然显著低于对照组（均P〈0．05）,但尿L／M值则与对照组差异无统计学意义（P〉0．05）。两组术后肛门排气时间差异无统计学意义（P〉0．05）。结论谷氨酰胺早期强化肠内营养具有良好的免疫耐受性．对进展期胃癌切除术中腹腔温热化疗患者术后肠黏膜屏障功能损害具有良好的保护作用。     

重症急性胰腺炎死亡的高危因素分析

目的探讨与重症急性胰腺炎（SAP）死亡相关的高危因素。方法回顾性分析2001年1月至2005年10月收治的141例SAP患者的临床资料。将患者分为死亡组和生存组,对可能影响SAP预后的15个因素采用Logistic回归分析。结果141例SAP患者中死亡34例（24．1％）。死亡组患者在年龄、体重指数、住院时间、APACHEⅡ评分和并发多器官功能障碍综合征（MODS）、腹腔室隔综合征（ACS）等方面与生存组相比差异有统计学意义（P〈0．05）。多因素分析显示,MODS（OR=67．358,P〈0．01）、APACHEII评分（OR=9．716,P〈0．01）和ACS（OR=5．775,P〈0．05）是早期影响SAP预后的独立危险因素;胰腺感染（OR=9．652,P〈0．01）、MODS（OR=5．212,P〈0．05）和腹腔出血（OR=4．707,P〈0．05）则是后期影响SAP预后的独立危险因素。结论SAP早期死亡的主要原因是MODS,特别是呼吸功能障碍和肾功能障碍,而后期死亡的主要原因是感染、MODS和腹腔出血。对高危因素进行早期预防和及时处理是降低SAP病死率的关键。     

区域灌注加贝酯联合血必净治疗重症急性胰腺炎临床分析

目的：2组患者在第1、7、14天二胺氧化酶、IL- 18、TNF-α、APACHE-Ⅱ评分均呈递减趋势;T抑制细胞(Ts)百分比下降;总T淋巴细胞、T辅助细胞(Th)、单核细胞HLA- DR表达（百分比）和单核细胞数呈上升趋势,实验组与对照组相比差异均有统计学意义(P＜0.05)。实验组与对照组相比,腹痛缓解时间、肠道...     

N-乙酰半胱氨酸对重症急性胰腺炎大鼠肠道屏障功能障碍与二次打击的保护作用

目的 观察N-乙酰半胱氨酸(NAC)对重症急性胰腺炎(SAP)大鼠肠屏障功能障碍与二次打击的防护作用.方法 雄性Wistar大鼠54只随机分为SAP组(n=24)、SAP+NAC组(n=24)和假手术组(n=6).建模后3、6、12、24 h,取腹主动脉血液和小肠、胰腺、肺脏、肝脏组织.光镜下观察小肠组织病理改变,检测各时段血浆肿瘤坏死因子(TNF)-α、白细胞介素-6(IL-6)和二胺氧化酶(DAO)活性,以及胰腺、肺脏、肝脏中髓过氧化物酶(MPO).结果 SAP组各时间点血液TNF-α、IL-6、DAO均较假手术组显著升高(P＜0.01),6、12、24 h胰腺、肺脏、肝脏MPO较假手术组显著升高(P＜0.05或P＜0.01);与SAP组比较,SAP+NAC组各时间点血液TNF-α、IL-6显著下降(P＜0.05或P＜0.01),6、12、24 h三个时间点DAO活性均显著降低(P＜0.05或P＜0.01),12、24h胰腺、肺脏、肝脏MPO显著减少(P＜0.05或P＜0.01).结论 NAC可有效防护SAP大鼠肠屏障功能障碍,并可减轻胰腺、肺脏、肝脏遭受二次打击的严重程度.     

Mortality Indicators and Risk Factors for Intra-Abdominal Hypertension in Severe Acute Pancreatitis

This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ² test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.Key words: Severe acute pancreatitis, Intra-abdominal hypertension, Risk factors, MortalityAcute pancreatitis (AP) most commonly presents with acute abdominal pain and is diagnosed on the basis of increased serum concentrations of amylase and lipase. Approximately 80% of AP patients recover, without complications, because the disease is mild and self-limiting in these patients. However, the mild, self-limiting form of AP may progress to severe AP (SAP) in approximately 20% of patients. SAP is characterized by pancreatic necrosis, local complications, and systemic organ failure; is associated with high morbidity; and has a considerably higher mortality rate (up to 30%) than mild AP.¹ A deeper understanding of the pathophysiology of SAP and a better assessment of disease severity will improve the management and outcomes of this complex disease.² The treatment for mild disease is supportive, whereas that for SAP involves management by a multidisciplinary team that includes gastroenterologists, interventional radiologists, and surgeons. In SAP patients, intra-abdominal hypertension (IAH) has drawn more attention. High IAH levels can significantly decrease perfusion of abdominal viscera and make tissues suffer hypoxic injury, which aggravates systemic inflammatory response syndrome.³ Persistent, elevated intra-abdominal pressure (IAP) could lead to a series of consequences, including cardiovascular and renal dysfunction and intestinal and hepatic ischemia, which could lead to a worse prognosis in patients with SAP.⁴ It has been shown that IAH is related to higher mortality and morbidity rates compared to patients with no IAH.⁵ However, the detailed mechanism underlying IAH in patients with SAP is still unclear. In this retrospective study, we identified the risk factors for mortality and the development of IAH in patients with SAP.     

肠源性内毒素在重症急性胰腺炎早期多脏器功能障碍中的作用

目的：通过动物实验探讨肠源性内毒素及肠道屏障功能障碍与大鼠重症急性胰腺炎（SAP）早期多脏器功能障碍的关系,进而探讨暴发性急性胰腺炎（FAP）的可能发病机制。方法：24只大鼠分为4组,每组6只．雌雄各半。①SAP组以5％牛磺胆酸钠逆行胰胆管注射法诱导;②SAP加结肠内毒素组先以5％牛磺胆酸钠诱导胰腺炎,再向结肠腔内灌注内毒素;③结肠内毒素组向结肠腔内灌注内毒素;④假手术组。制模8h后处死大鼠,记录大鼠腹主动脉之最大采血量（间接反映其有效循环血量）和腹水量;测定血液、腹水的生化指标及细胞因子浓度;测定血二胺氧化酶（DAO）浓度;制作各脏器病理切片并予评分。结果：SAP加肠道内毒素组与SAP组大鼠相比,循环血量明显减少,腹水量明显增加．肾功能减低,血淀粉酶升高,腹水的TNF—α及淀粉酶值明显升高,胰、肺、肾、肠的病理改变明显,出现早期的多脏器功能障碍。而未诱导SAP的大鼠单纯肠道内注射相同剂量内毒素,并未造成脏器功能的改变,各检测指标与对照组相比差异无统计学意义：血DAO浓度也无明显升高。结论：SAP大鼠肠道内大量内毒素的存在及肠道黏膜屏障功能受损,使肠源性内毒素发生易位,是大鼠出现早期多脏器功能障碍的重要机制。     

大黄附子汤对重症急性胰腺炎早期大鼠肠黏膜机械屏障的影响及其意义

目的:观察大黄附子汤(DHFZT)对早期重症急性胰腺炎肠黏膜机械屏障的影响。方法:24只雄性SD大鼠采用随机数字表法分为4组：假手术(SH)组、假手术-DHFZT(SH-DHFZT)组、重症急性胰腺炎(SAP)组、DHFZT治疗(SAP-DHFZT)组,每组6只。SH组、SH-DHFZT组大鼠开腹后,翻动胰腺数次后关腹...     

重症急性胰腺炎死亡相关危险因素的Logistic回归分析

[摘 要] 目的 探讨重症急性胰腺炎（SAP）死亡相关的危险因素,为临床采取预防及干预措施提供依据。方法 将沧州市人民医院2006年3月至2016年6月收治入院的139例SAP患者根据结局分为存活组（n=116）和死亡组（n=23）,对相关危险因素进行Logistic分析。结果 存活组和死亡组的年龄、APACHE II评分及CT严重指数存在统计学差异（P < 0.05）;两组的动脉血pH值、血氧饱和度、入院24 h尿量、血液生化指标（红细胞压积、血清白蛋白、肌酐、尿素氮、低密度脂蛋白）、凝血功能指标（凝血酶原时间、纤维蛋白原、 D-二聚体）存在统计学差异（P < 0.05）;死亡组急性呼吸窘迫综合征（ARDS）、肝功能障碍、肾功能障碍发生率高于生存组（P < 0.05）,合并多器官功能障碍（MODS）、腹水、休克及胰腺假性囊肿的发生率也明显高于生存组（P < 0.05）。Logistic回归分析显示,年龄（OR=2.01,95%Ci=1.98～2.56,P=0.0102）,ARDS（OR=27.56,95%Ci=15.23～70.03,P < 0.001）,肝功能不全（OR=16.21,95%Ci=7.98～30.87,P < 0.001）,肾功能不全（OR=6.78,95%Ci=3.21～13.11,P=0.0157）及多器官功能不全（OR=20.19,95%Ci=14.12～54.26,P < 0.001）是引起SAP患者死亡的独立危险因素。结论 本研究显示SAP死亡相关的独立危险因素主要包括年龄、ARDS、肝功能不全、肾功能不全及多器官功能不全。