重症急性胰腺炎早期手术指征的探讨

目的 探讨ＳＡＰ的早期手术指征。方法 回顾分析１１例采用非手术治疗ＳＡＰⅡ级病例的死亡原因。结果 １１例ＳＡＰ均死于疾病早期，并发休克、ＭＯＦ是早期的死亡原因。结论 ＳＡＰ早期应有选择性地采用手术治疗。     

Cholecystokinin in the early course of acute post-ERCP pancreatitis

Background: A high dose of cholecystokinin (CCK) agonist cerulein can induce acute pancreatitis in animals. The role of CCK in the induction of acute pancreatitis in humans is unclear. We investigated basal plasma CCK levels before and after induction of post-ERCP pancreatitis to determine CCK levels in the early course of the disease.

Study Design: We determined plasma CCK concentrations in four groups of patients who underwent ERCP: (1) post-ERCP pancreatitis patients (n = 23); (2) patients with post-ERCP hyperamylasemia without pancreatitis (n = 5); (3) patients with post-ERCP abdominal pain without hyperamylasemia (n = 18); and (4) patients with an uneventful post-ERCP period (n = 43). Plasma samples were taken before ERCP, 4 to 8 hours, 10 to 16 hours, and 24 hours after ERCP. Plasma CCK concentrations were determined by a specific and sensitive radioimmunoassay using CCK antiserum (Euro-Diagnostica, Malmö, Sweden).

Results: Plasma CCK levels increased five-fold early in the course in post-ERCP pancreatitis patients, but not in post-ERCP hyperamylasemia patients or in uncomplicated ERCP patients, where CCK levels temporarily decreased after ERCP. In patients with abdominal pain, CCK levels did not change. After the early increase, plasma CCK levels declined to almost unmeasurable levels one day after the onset of symptoms in post-ERCP pancreatitis. In other groups CCK levels were close to the pre-ERCP level.

Conclusions: It remains to be shown whether CCK is important in the pathogenesis of post-ERCP pancreatitis or merely a secondary phenomenon. There is a rationale to test CCK antagonists in preventing post-ERCP pancreatitis.     

早期血滤对重症急性胰腺炎家猪血浆细胞因子水平的影响

目的　探讨早期血液滤过对重症急性胰腺炎 (SAP)家猪促抗炎细胞因子血浆水平的影响。方法　采用胰管逆行灌注人工胆汁的方法复制家猪SAP模型 ,随机分为胰腺炎血滤治疗组(HF组 ,n =8)和胰腺炎非血滤治疗组 (NHF组 ,n =8)。HF组使用高容量、零平衡血滤。用酶联免疫吸附试验检测两组动物建模前后血浆肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 1β、IL 10的水平。结果　与NHF组相比 ,血滤治疗后HF组家猪TNF α、IL 1β的血浆水平较低 [血滤停止前( 618± 2 76)ng/L较 ( 13 75± 3 3 4)ng/L ;( 4 45± 14 1)ng/L较 ( 965± 2 65 )ng/L ,P <0 .0 1] ,IL 10与TNF α的比值较高 [血滤停止前 ( 0 .3 5 4± 0 .114 )较 ( 0 .12 5± 0 .0 3 2 ) ,P <0 .0 1]。结论　早期血滤能降低SAP家猪促炎细胞因子TNF α,IL 1β的血浆水平 ,升高IL 10 /TNF α的比值 ,使促抗炎细胞因子失衡得到部分纠正。     

Prognosis of an acute pancreatitis and its postop course

Dynamical investigation of clinical and laboratory indexes in 108 patients, in whom 155 operative interventions were performed for destructive pancreatitis, was done. The statistically trustworthy difference in the indexes obtained in the patients was established after performance of the first operation and in those who were reoperated on.     

Natural course of acute pancreatitis

Escherichia coli . It has been confirmed that after necrotizing pancreatitis a considerable large group of patients suffer long-lasting exocrine and endocrine insufficiency.     

重症胰腺炎的手术指征探讨

目的:探讨重症急性胰腺炎(SAP)的手术指征。方法:回顾分析23例SAP的预后。结果:4例死于急性反应期,3例死于全身感染期,并发休克、脓毒血症、MOF是主要死亡原因。结论:SAP应选择性地采用手术治疗,特别是并发胰周或腹腔感染。     

Changes in free amino acid plasma levels in patients with acute pancreatitis and their correction with early parenteral feeding

The lowering of general pool of free amino acids in the blood plasma by 54.9%, comparing with their content in practically healthy persons, was observed in 17 patients with an acute pancreatitis. And by this the content of the majority of amino acids was lowered, excluding glutamate, phenylalanine and methionine, the level of which had raised. Under the conventional treatment influence the amino acids concentration had enhanced and constituted 60% from such in the control group, while in application of parenteral nutrition (intravenous infusion of the infezol 40 solution)--85.9%. By that the formation of the polyorganic insufficiency syndrome was not noted and the level of each amino acid had normalized.     

Changes of cytokine levels in the serum in patients with acute pancreatitis as an early symptom for diagnosis

Changes of concentration of proinflammatory cytokines--tumor necrosis factor (TNF), interleukin-1, growth transforming factor, granulocyte--macrophage colony stimulating factor in the blood serum of patients with probable diagnosis of an acute pancreatitis (AP) were examined. Seven days before the disease occurrence the TNF concentration rise was observed, what proved, by the authors opinion, its significance as an early diagnostic criterion for AP. Other diagnostic methods did not prove their information value in determination of the disease occurrence during the 7 day premorbid period.     

Fluid sequestration: an early indicator of mortality in acute pancreatitis

Complete daily intake and output charts were available for 218 patients with acute pancreatitis. The patients were divided into three groups according to the relation between fluid intake and output. In 105 patients in whom there was negligible fluid sequestration (daily output within 2 litres of intake) there were six deaths (5.8 per cent). In 69 patients the daily fluid intake exceeded the output by 2 litres or more but this imbalance lasted for 48 h or less; six patients died (8.7 per cent). The remaining 44 patients sequestered 2 litres or more of fluid per day for more than 48 h or until death. Thirty-eight patients in this group died (86.4 per cent). Fluid sequestration of 2 litres or more per day, and lasting longer than 48 h, is an accurate and simple predictor of mortality in acute pancreatitis. In this study it had a sensitivity of 76 per cent and a specificity of 96 per cent. The predictive value of a positive result was 86 per cent and of a negative result 93 per cent (efficiency 92 per cent).     

Glucagon levels in acute pancreatitis.

Blood glucagon levels were found to be elevated in patients with acute pancreatitis. The significance of this in the individual patient is obscure, and there was a marked variability from patient to patient.     

重症胰腺炎手术指征和手术时机的探讨

目的 探讨重症且腺炎的手术指征和手术时机。方法 回顾性分析８２例重症胰腺炎的治疗情况,其中行非手术治疗１０例、早期手术４４例、延期手术２８例。结果 本组总并发症发生率为２４％、总病死率为１８％。非手术组１０例均痊愈,并发症发生率为１０％;早期手术组死亡５例,并发症经和病死率分别为１４％和１１％;延期手术组死亡１０例,并发症发生率和病死率分别为４６％和３６％,两组相比差异有显著意义（Ｐ＜０.０１、Ｐ＜０.０５）。延期手术组中,无明显感染者其并发症发生率和病死率明显低于有严重感染及重要器官功能不全者（Ｐ＜０.０１、Ｐ＜０.０５）。结论 早期手术治疗对于一些重症胰腺炎患者仍然是必需的。胰腺坏死广泛者宜在发生严惩感染前进行手术。     

Elevation of plasma thrombomodulin level in diabetic patients with early diabetic nephropathy

Thrombomodulin (TM) is a membrane protein in the vascular endothelium, and it plays an important role as a cofactor in the thrombin-catalyzed activation of protein C. It has also been found in human plasma; however, its clinical significance is not known. In this study, fasting plasma TM concentrations in 67 diabetic patients with different degrees of albuminuria (39 men aged 57 +/- 8 yr, 28 women aged 57 +/- 11 yr; means +/- SD) and 34 age- and sex-matched healthy subjects were investigated by use of a one-step sandwich enzyme immunoassay, a new method developed by H.I. and others. As a screening, the patients were divided into three groups according to the first morning urinary concentrations of albumin: group 1, less than 30 micrograms/ml (normoalbuminuria); group 2, 30-140 micrograms/ml (microalbuminuria); group 3, greater than 140 micrograms/ml (clinical nephropathy). There was no significant difference in plasma TM level between the control group (17.7 +/- 3.7 ng/ml, n = 34) and group 1 (16.9 +/- 3.4 ng/ml, n = 30); however, plasma TM concentrations in group 2 (22.8 +/- 3.4 ng/ml, n = 22) and group 3 (29.6 +/- 6.1 ng/ml, n = 15) increased significantly compared with those in the control group and group 1, respectively. As a further investigation, three timed overnight urine collections were made. The patients were allocated to three groups according to their rates of albumin excretion: group I, less than 20 micrograms/min (normoalbuminuria); group II, 20-200 micrograms/min (microalbuminuria); group III greater than 200 micrograms/min (clinical nephropathy).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostication of severity of the course in acute pancreatitis

The authors picked out 200 case records of the patients with acute pancreatitis using a method of random sample. By means of the method of step-by-step discriminant analysis, the severity of the course of the disease was prognosticated. The age of a patient, duration of the disease, body temperature, leukocytic count and glucose level in the blood, amylase activity in the urine, presence of another pathology were analysed. The solving rule permitting to prognosticate an outcome of the disease with a high degree of probability was obtained. A variable directly dependent on the severity of a course of the disease--"degree of the severity of acute pancreatitis" was established.     

重症急性胰腺炎的早期处理

20世纪60年代以前,急性坏死性胰腺炎的病死率非常高,无论内科治疗或外科治疗几乎95%以上都死亡,因此对急性坏死性胰腺炎应属于何科治疗尚存在不一致的意见,直到1963年watt对1例出血性胰腺炎作全胰切除存活后,大部分外科医师又同意采用外科手术治疗急性坏死性胰腺炎.