腹膜透析腹腔灌洗术联合生大黄胃肠注入治疗重症急性胰腺炎

目的 观察早期进行腹膜透析液腹腔灌洗并结合生大黄胃肠道注入治疗重症急性胰腺炎的疗效。方法确诊为重症急性胰腺炎的病人12例，均合并脏器功能不全和腹水，局麻下分别于右上腹和下腹正中置入腹膜透析一根，用1．5％ Baxter腹膜透析液灌洗，每日6000ml，生大黄30g每日2次胃管注入。观察血液分析、血尿淀粉酶、血气分析和肝肾功能。结果 12例病人均治愈，无严重并发症出现。痛程较传统治疗缩短。结论 初步认为腹膜透析腹腔联合生大黄胃肠注入治疗重症急性胰腺炎是一种有效的治疗方法。     

早期腹腔穿刺引流治疗重症急性胰腺炎的疗效观察

目的：研究分析早期腹腔穿刺引流应用于重症急性胰腺炎的临床治疗效果。方法选择2001年12月~2013年12月在我院接受治疗的102例重症急性胰腺炎患者,随机性将其分成观察组与对照组,观察组51例患者在早期采取腹腔穿刺引流治疗,对照组51例患者在早期未采取腹腔穿刺引流治疗。结果观察组51例患者在膀胱压、APACCHE I 评分等方面与对照组相比,差异<0.05有统计学意义。观察组患者发生多器官功能障碍综合征、急性肾功能衰竭、急性呼吸窘迫综合征的机率显著性小于对照组,差异<0.05有统计学意义。结论早期腹腔穿刺引流治疗能够减小重症胰腺炎患者的腹腔压力,并且能够降低发生脏器功能衰竭的可能,临床实用、推广价值较高。     

136例重症急性胰腺炎的治疗方法与疗效评估

目的探讨重症急性胰腺炎（SAP）的治疗方法与疗效。方法总结分析2001年3月至2008年3月间收治的136例重症急性胰腺炎的临床病例资料。结果102例行非手术治疗,死亡8例（7．8％）,并发假性囊肿12例（11．8％）。34例行手术治疗,术后死亡8例（23．5％）,并发假性囊肿4例（11．8％）,腹腔内出血6例（17．6％）,胰瘘8例（23．5％）,肠瘘2例（5．9％）。结论重症急性胰腺炎以非手术治疗为主的个体化原则,综合治疗效果明显优于早期手术治疗。如果病情加重合并脏器功能障碍、黄染加重、胰周大量积液、高热、疑有胰周或胆道感染者应正确把握重症胰腺炎的外科手术时机,合理选择手术方式对决定重症胰腺炎的预后很重要。     

右旋糖酐治疗急性重症胰腺炎的疗效观察

急性重症胰腺炎(SAP)是临床的急症之一,其发病迅速,来势凶猛,而且病死率较高,可达20%～60%,因此,已成为临床医学一大难题。随着医学的发展,对该疾病有了更深刻的认识,尤其微循环障碍被认为是SAP的主要发病机制之一,更受到了现代医学的重视。动物实验及临床应用证实,低分子右旋糖酐可改善急性重症胰腺炎血液流变学异常,改善其微循环。据此,我们对60例SAP病人进行对照研究,探讨低分子右旋糖酐在临床治疗SAP中的价值,现报告如下。资料和方法1临床资料2004年2月～2007年2月共收治SAP病人60例,其中男33例,女27例,年龄46～78岁,平均63.8岁。…     

银杏叶注射液在治疗重症急性胰腺炎中的辅助作用

目的 观察银杏注射液在治疗重症急性胰腺炎中的辅助作用.方法 将49例重症急性胰腺炎患者随机分为2组,治疗组25例,在一般治疗基础上应用银杏叶注射液20ml+生理盐水250ml静脉滴注,1次/日;对照组24例,为一般治疗.观察患者治疗后腹痛、腹部压痛返跳痛消失时间、血淀粉酶、CRP变化、住院天数等指标.结果 治疗组在腹痛、腹部压痛反跳痛消失、血CRP、血淀粉酶恢复正常平均时间、并发症发生率等方面与对照组比较,差异显著,有统计学意义.结论 银杏叶注射液在治疗重症急性胰炎上有良好的辅助作用,值得推广应用.     

大黄联合乌司他丁治疗重症急性胰腺炎的研究

目的探讨早期大黄联合应用乌司他丁治疗重症急性胰腺炎患者的疗效及其对血清中细胞因子IL-6、IL-8水平的影响。方法将来自本院住院的患者（57例）分成标准的常规治疗组（18例）、乌司他丁治疗组（19例）及乌司他丁＋大黄治疗组（20例），将本院门诊体检的健康者（16例）作为空白对照。采用放射免疫学法测定其外周血清中IL-6、IL-8水平，并评价各治疗组的病死率、治疗有效率、腹痛腹胀缓解时间和平均住院时间。结果重症急性胰腺炎早期上述细胞因子在患者血清中水平明显升高，经治疗5d后，存活者各组的上述细胞因子水平下降，前后比较差异有统计学意义（P〈0．01）。大黄联用乌司他丁治疗后存活者的腹痛腹胀缓解时间、平均住院时间较其它两组缩短，治疗有效率增高（P〈0．05），但3种治疗方法的病死率差异无统计学意义（P〉0．05）；机体细胞因子IL-6、IL-8水平迅速下降，较常规治疗及乌司他丁治疗组下降水平更明显，结果相比差异有统计学意义（P〈0．01）。结论早期大黄联用乌司他丁治疗重症急性胰腺炎患者．有利于提高治疗效果。     

急性重症胰腺炎临床治疗分析

目的：探究急性重症胰腺炎患者采用的治疗方法和治疗效果。方法选取2013年3月~2014年2月收治的63例急性重症胰腺炎患者进行治疗,随机分组,实验组40例患者采取非手术治疗,对照组23例患者进行手术治疗,对比患者的治疗效果。结果实验组治疗有效率为90.0%,并发症的发生率为10%,对照组治疗有效率为73.9%,并发症的发生率为26.1%。两组患者的疗效和并发症差异较大,有统计学意义(P<0.05)。结论急性重症胰腺炎患者采取非手术的保守治疗,疗效显著,安全可靠,值得推荐。     

重症急性胰腺炎外科手术治疗经验总结

目的总结重症急性胰腺炎（SAP）的手术治疗经验,以寻求更好的手术治疗效果。方法对比分析2002～2005年以早期手术为主的36例SAP（A组）与2006～2009年以非手术治疗为主的44例SAP（B组）的治愈率和死亡率。结果 A组手术死亡率33.3%（12/36）,治愈率66.7%（24/36）。B组死亡6例,保守治疗的死亡率13.6%（6/44）,治愈率86.4%（38/44）。结论对SAP手术时机的把握和手术方式的选择极为重要,直接影响手术效果。SAP早期以保守治疗为主,后期针对局部感染并发症进行治疗,可使SAP手术死亡率显著降低。     

乌司他丁与生长抑素治疗重症急性胰腺炎临床疗效观察

目的 比较乌司他丁和生长抑素治疗重症急性胰腺炎的临床疗效。方法 选择我院2017年7月~2018年7月收治的68例重症急性胰腺炎患者,随机分为对照组32例和观察组36例,两组患者均接受常规治疗,对照组在此基础上应用生长抑素治疗,观察组使用乌司他丁治疗。记录两组患者上腹部压痛缓解时间、腹痛恢复时间、血淀粉酶恢复时间,IL-6、IL-8、IL-10、TNF-α改善水平,比较两组治疗有效率。结果 观察组患者的上腹部压痛缓解时间、腹痛恢复时间、血淀粉酶恢复时间均少于对照组,差异有统计学意义（P＜0.05）;观察组患者的IL-6、IL-8、IL-10、TNF-α改善效果均优于对照组,差异有统计学意义（P＜0.05）;观察组治疗有效率为94.44%,高于对照组的75.00%,差异有统计学意义（P＜0.05）。结论 应用乌司他丁为重症急性胰腺炎患者治疗可有效改善各项炎症介质,缩短各项指标和症状的改善时间,临床应用可行性高。     

Clinical Observation of Immunity for Severe Acute Pancreatitis

The aim of our study was to observe the dynamic changes of immunity for patients with severe acute pancreatitis (SAP) and intervention by traditional Chinese medicine. Twenty-three patients who met the inclusion criteria were randomized to combined treatment of traditional Chinese medicine and Western medicine (TCM) or conventional western medicine treatment (WM) groups. The clinical data for all patients were collected. Peripheral venous blood samples were obtained from patients on days 1, 7, 14, and 28 after admission. Biochemical data including the percentage of CD4+/CD8+/natural killer (NK) cells/B lymphocytes/HLA-DR and CD4+/CD8+ ratio in serum were determined by flow cytometer. Patients’ characteristics and immunity at admission were similar between the two groups. The secondary infection was different. The levels of T-lymphocyte subsets in the TCM group were quite different from the WM group, with much more the percentage of CD4+ and the CD4+/CD8+ ratio on days 7, 14, and 28 and much less the percentage of CD8+ on days 14 and 28. On days 14 and 28, the levels of NK cells and B lymphocytes were significantly higher in the TCM group compared with the controls. Compared with the TCM group, the levels of HLA-DR were significantly decreased in the WM group on days 7, 14, and 28. The immune dysregulation exists in the development and progression of SAP. The combined treatment of traditional Chinese medicine and western medicine can upregulate the patient’s immune and maintain the immune balance.     

重症急性胰腺炎48例临床分析

目的探讨48例重症急性胰腺炎病例非手术治疗和手术治疗的指征、措施及其效果。方法回顾性分析48例重症急性胰腺炎病例的临床资料,并分组比较。结果确诊病例48例,手术治疗组22例,4例手术后10 d内死亡,死于多器官功能衰竭。2例于术后1个月死亡,死于胰周感染及营养不良。非手术治疗组26例,死亡2人,均死于多器官功能衰竭。结论重症急性胰腺炎(SAP)早期以非手术治疗为主。但是胆源性伴胆道梗阻当经积极治疗而病情不断加重时,则需采取早期手术治疗。     

重症急性胰腺炎手术干预的时机与预后分析

目的 探讨重症急性胰腺炎手术干预最佳时机.方法 1980～2006年经治的168例重症急性胰腺炎,按治疗方法和手术时间不同分为A、B、C三个组,回顾性分析治疗效果.结果 1980～1990为A组(57例),治疗简单,以早期(72h)手术为主,手术率80.7%,病死率66.7%;1991～1996年为B组(31例),以"个体化治疗方案"并适当延期(13～19d,平均16d)手术清创为主,手术率45.2%,病死率29%;1997～2006年为C组(80例),以综合治疗及延期(13～30d,平均21.5d)手术引流为主,手术率32.5%,病死率11.6%.结论 重症急性胰腺炎的关健问题是坏死组织感染,深入认识其病生变化及疾病过程,合理安排综合治疗,正确选择手术时机,可提高疗效,改善预后.     

Efficacy and Mechanism of Salvia Miltiorrhizae Injection in the Treatment of Rats with Severe Acute Pancreatitis

To study the efficacy and mechanism of Salvia miltiorrhizae injection in the treatment of severe acute pancreatitis. SAP rat models were prepared and randomly divided into model control group and treated group. The sham-operated group was also set. At 3, 6 and 12 h after operation, the mortality rate, ascitic volumes, pathological changes in the pancreas, contents of amylase and endotoxin in plasma as well as IL-6, IL-18, ET-1 and NO in serum, the staining intensity of Bax and NF-κB p56 proteins, and the changes in apoptosis index of pancreatic cells in rats in each group were observed. The pathological severity scores (at 3, 6 and 12 h after operation), contents of plasma endotoxin (at 6 and 12 h after operation) and serum IL-6 (at 6 and 12 h after operation) were significantly lower than those in model control group (P < 0.05, P < 0.01 and P < 0.01, respectively); the staining intensity and the product of the staining intensity and positive staining rate of Bax protein in the pancreas were significanly higher than those in model control group (P < 0.01). Salvia miltiorrhizae is able to reduce the contents of plasma endotoxin and serum IL-6, promote the expression of Bax protein in pancreas, improve the pathological changes in the pancreas, and decrease the mortality rate of rats, thereby showing therapeutic effect on rats with SAP. Supported by technological foundation project of Traditional Chinese Medicine Science of Zhejiang province (no. 2003C130; no. 2004C142), foundation project for medical science and technology of Zhejiang province (no. 2003B134), grave foundation project for technological and development of Hangzhou (no. 2003123B19), intensive foundation project for technology of Hangzhou (no. 2004Z006), foundation project for medical science and technology of Hangzhou (no. 2003A004) and foundation project for technology of Hangzhou (no. 2005224) We claimed that this paper was original and would not have any financial interest in a company or its competitor, and that all authors meet standard for authorship. We abided the ethics in this animal experiment study. The ethics committee approval of our hospital was secured for the animal study reported, and all rats have not been abused and executive mercy killing when the observing time in this study was over.     

重症急性胰腺炎大鼠胰腺内分泌功能研究

目的:观察重症急性胰腺炎(SAP)大鼠胰腺内分泌功能的变化。方法:雄性Wistar大鼠48只,随机分为假手术组(SO组)、重症急性胰腺炎组(SAP组),每组24只。以胆胰管逆行注射5%牛磺胆酸钠制备SAP模型。成模术后3h、6h、12h分批心脏取血后处死大鼠。肉眼观察胰腺大体形态,显微镜下观察胰头部组织病理学变化并评分,并平行检测各组各时间点血清淀粉酶(AMY)、胰岛素(INS)、C-肽(CP)和胰高血糖素(GG)水平。结果:SAP大鼠随成模时间延长胰腺外分泌部损伤逐渐加重,并在12h达高峰,但内分泌部胰岛仅在12h出现形态学变化。SAP组大鼠成模3h、6h和12h血清INS和CP水平均较SO组升高,差异有统计学意义(P<0.05);6h和12h血清GG与SO组相比明显升高,差异有统计学意义(P<0.05)。结论:SAP大鼠存在胰腺内分泌部损伤,表现为分泌激素水平紊乱。     

Immune Dysregulation in Patients with Severe Acute Pancreatitis

To investigate patients with severe acute pancreatitis (SAP) by dynamic levels of pro-/anti-inflammatory cytokines and endotoxin (ET) in plasma and the relationship between immunity and infection, organ dysfunction. Seventy-two patients with SAP were recruited. The ET, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-4 (IL-4) were determined on admission and days 3, 7, and 14. For comparison, patients were analyzed through infection group versus non-infection group, multiple organ dysfunction syndrome (MODS) group versus non-MODS group. There were sixteen patients with secondary infection, twenty-two with MODS, and nine deaths. The infection group had higher levels of ET than the non-infection group on days 3 and 7. The dynamic cytokine levels of patients in the MODS group were unanimous with those outcomes in the infection group. The levels of cytokines in the infection group were different from the non-infection group, with more levels of TNF-α, IL-6 on days 3 and 7 and less on days 14, and more levels of IL-10, IL-4 on days7 and 14. The levels of TNF-α, IL-6 in the MODS group were different from the non-MODS group, with more levels on days 3 and 7, and less levels on days 14. Immune dysregulation may play an important role in infection and organ dysfunction for patients with SAP.     

Baicalin Protects Thymus of Rats with Severe Acute Pancreatitis

To study the protective role of Baicalin on rats thymus with severe acute pancreatitis (SAP). The SAP rats were randomly assigned to the model control, Baicalin treated and Octreotide treated groups. Normal rats were assigned to the sham-operated group. The rat survival rates, pathological changes of thymus, apoptotic indexes and expression levels of NF-κB, Bax, Bcl-2, Caspase-3 and P-selectin of all groups were observed and recorded at 3, 6 and 12 h after operation, respectively. Rat survival rates were significantly higher in both Baicalin- and Octreotide-treated groups than those in the model control group at 12 h (P?<?0.05). The thymus pathological score was significantly lower in Baicalin treated group than in control group at 3 and 12 h (P?<?0.05). The expression of NF-κB, Bax and Bcl-2 in thymus tissue was negative in all groups. At 3 h after operation, the staining intensity, positive staining rate and intensity of Caspase-3 protein in the thymuses of the Baicalin treated group were significantly higher than those in the model control group (P?<?0.01). At different time points after operation, no marked difference was observed in the staining intensity of P-selectin protein between the Baicalin treated group and the model control group (P?>?0.05). At 6 h after operation, the positive staining rate and intensity of P-selectin protein in the Baicalin treated group was significantly lower than those in the model control group (P?<?0.05). The apoptotic indexes were significantly higher in treated group than in model control group at 6 h (P?<?0.05). Baicalin has a protective role on the thymus of SAP rats, and its effect of decreasing inflammatory mediators level in blood, inhibiting P-selectin expression and inducing apoptosis of thymocytes may involve in the mechanism of its protective role.