不同评分系统对重症急性胰腺炎预后评估的临床价值

目的 探讨评估重症急性胰腺炎(SAP)的不同方法对SAP预后的判断效果.方法 回顾性分析10年间收治168例SAP患者的临床资料.运用受试者工作特征曲线(ROC曲线)下面积,单因素和多因素分析评价序贯器官衰竭评分(SOFA)、急性生理和慢性健康评估(APACHE Ⅱ)及CT严重性指数(CTSI)对SAP预后结果的预测能力.结果 ROC曲线面积比较:SOFA,APACHEⅡ,CTSI的ROC曲线下面积分别为0.846,0.809和0.779;SOFA与CTSI评分比较,差异有统计学意义(Z=2.68,P<0.01);APACHEⅡ与SOFA,CTSI比较,差异无统计学意义(Z=1.079,P>0.05和Z=0.693,P>0.05).单因素分析显示,住院期最大SOFA计分、最大APACHE Ⅱ评分、最大CT计分指数、年龄、胰腺感染等与SAP预后相关;多因素分析表明,最大SOFA计分、最大APACHE Ⅱ评分、最大CT计分指数为SAP预后判别预测的独立相关因素.联合评价表明,三者阳性与二者阳性或一个阳性的SAP患者病死率比较,有统计学意义(P<0.05).结论 动态观测SAP患者住院期间的SOFA,APACHE Ⅱ和CTSI对SAP预后有较强的判别预测能力,联合三者建立的判别方程具有更佳的SAP预后判别效果.     

新亚特兰大分类下不同CT评分标准早期预测急性胰腺炎器官衰竭的价值比较

目的基于急性胰腺炎新亚特兰大分类,比较Balthazar CT严重指数(Balthazar computed tomography severity index,CTSI)、修正CT严重指数(modified computed tomography severity index,MCTSI)和胰腺外炎症评分(extrapancreatic inflammation on CT,EPIC)对急性胰腺炎早期发生器官衰竭的预测价值。方法回顾性分析2013年12月至2014年1月期间笔者所在医院因急性胰腺炎入院治疗患者的临床资料,绘制其CTSI、MCTSI、EPIC、局部并发症及急性胰腺炎严重程度床边指数(beside index of severity in acute pancreatitis,BISAP)和新日本急性胰腺炎严重程度评分(new Japanese severity score,NJSS)诊断早期器官衰竭的受试者特征曲线,计算曲线下面积。结果 1 54例患者基线资料如年龄、性别、首次腹痛至检查间隔时间方面的差异均无统计学意义(P0.05)。2 CTSI、MCTSI、EPIC及局部并发症评价早期器官衰竭具有统计学意义(P0.05)。临床评分系统BISAP和NJSS评价早期器官衰竭无统计学意义(P0.05)。结论 CT评分系统能在早期准确预测急性胰腺炎发生器官衰竭情况。     

入院时血糖与急性胰腺炎预后的相关性分析

目的 研究入院时血糖在评估急性胰腺炎(AP)预后中的作用.方法 分别采用APACHEⅡ评分标准、Balthazar CT分级系统对我院2008年8月至2010年12月收治资料完整的199例AP患者(排除糖尿病患者)入院时的病情严重程度作回顾性分析,若同时符合APACHEⅡ评分标准≥8分,Balthazar CT分级达到D级或E级者拟诊为重症急性胰腺炎(SAP).同时详细记录患者的入院时血糖、年龄、性别、病因及并发症情况,通过分析入院时血糖与以上临床指标的相关性,以了解其与胰腺炎预后的关系.结果 199例患者中SAP 19例,轻型急性胰腺炎(MAP)180例.SAP患者的平均血糖为(13.07±3.23)mmol/L,显著高于MAP患者的平均血糖(8.37±3.84)mmol/L.入院时血糖水平与APACHEⅡ评分、住院费用、Balthazar CT分级、CTSI评分及并发症发生率相关(r=0.610,0.356,0.271,0.324,0.334,P＜0.05).结论 入院时血糖水平与AP的病变程度成正相关,反映了AP的病情严重程度,可作为预后评估的有效指标之一.     

两种CT严重指数评分与急性胰腺炎严重程度床边指数评分在评估重症急性胰腺炎中的相关性分析

目的探讨重症急性胰腺炎(SAP)患者CT严重指数(CTSI)、修正CT严重指数(MCTSI)与急性胰腺炎严重程度床边指数(BISAP)的相关性。方法前瞻性收集2015年7月至2015年10月期间确诊为急性胰腺炎的患者112例,纳入其中诊断为SAP的患者38例,对其采用两种CT评分标准(CTSI及MCTSI)和BISAP评分标准进行评分。采用SPSS 19.0软件分析两种CT评分结果与BISAP评分结果的相关性,对于观测者的一致性用Kappa检验分析。MCTSI和CTSI分别与BISAP的相关性用Spearman等级相关分析。检验水准α=0.05。结果BISAP评分两位观察者评定结果均为Ⅰ级者3例(8.9%),Ⅱ级者20例(52.6%),Ⅲ级者15例(39.5%),观察者间一致性强(Kappa=1,P0.01);CTSI评分两位观察者结果均为Ⅰ级者6例(15.8%),Ⅱ级者22例(57.9%),Ⅲ级者10例(26.3%),观察者间一致性较好(Kappa=0.748,95%CI 0.000~0.076,P0.01);MCTSI评分两位观察者结果均为Ⅰ级者2例(5.3%),Ⅱ级者19例(50.0%),Ⅲ级者17例(44.7%),观察者间一致性较好(Kappa=0.788,95%CI0.000~0.076,P0.01)。CTSI评分与BISAP评分呈正相关(rs=0.385,P=0.001),MCISI与BISAP评分也呈正相关(rs=0.326,P=0.004)。结论两种CT严重指数评分评价SAP,CTSI评分和MCTSI评分与BISAP评分均趋于正相关,但是相关性都较弱。     

低分子肝素治疗重症急性胰腺炎的临床效果分析及机制研究

目的:探讨低分子肝素(LMWH)对重症急性胰腺炎(SAP)的临床疗效及可能机制。方法:采用前瞻性研究,将126例SAP患者分为普通治疗组(A组)和普通治疗+LMWH治疗组(B组),治疗2周后对比两组患者血清NO浓度、APACHⅡ评分、临床症状改善程度、胰腺Balthazar CT分级。结果:与A组相比,治疗2周后B组血清NO浓度显著升高(P0.01)、APACHⅡ评分显著降低(P0.01),临床症状显著改善(P0.01),胰腺Balthazar CT分级显著降低(P0.01)。结论:LMWH可能通过增加NO合成,利用其扩血管作用增加胰腺血流量,改善胰腺微循环障碍,发挥辅助性治疗作用,改善SAP转归。     

重症急性胰腺炎合并胰腺假性囊肿的微创手术治疗

探讨微创手术治疗重症急性胰腺炎(SAP)合并胰腺假性囊肿的效果。63例SAP合并胰腺假性囊肿患者分成对照组和实验组。对照组采用开腹手术治疗,实验组采用内镜联合腹腔镜手术治疗。实验组手术时间、术中出血量、排气时间、住院时间均少于对照组(P0.05);两组手术治疗有效率差异无统计学意义(P0.05),术后并发症发生率低于对照组(P0.05);实验组腹痛评分、恶心评分、呕吐评分均明显优于对照组,两组比较差异具有统计学意义(P0.05)。内镜联合腹腔镜手术治疗SAP合并胰腺假性囊肿效果显著。     

三种CT评分与急性胰腺炎严重程度床边指数评分评估重症急性胰腺炎的相关性研究

目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)患者三种CT评分即CT严重指数(CT severity index,CTSI)、修正CT严重指数(modified computed tomography severity index,MCTSI)、胰腺外炎症CT(extra-pancreatic inflammation on CT,EPIC)评分分别与急性胰腺炎严重程度床边指数(bedside index of severity in acute pancreatitis,BISAP)的相关性。方法前瞻性收集2015年7~11月期间确诊为急性胰腺炎的患者135例,纳入其中诊断为SAP的患者45例,对其采用三种CT评分标准(CTSI、MCTSI及EPIC)和BISAP评分标准进行评分,分析三种CT评分结果与BISAP评分结果的相关性。对于CTSI、MCTSI及EPIC评分在两位观察者间的一致性用Kappa检验分析。MCTSI、CTSI及EPIC分别与BISAP的相关性用Spearman等级相关分析。检验水准α=0.05。结果 BISAP评分Ⅰ级者4例,Ⅱ级者22例,Ⅲ级者19例,总评分为(2.41±0.82)分。CTSI的评分结果为Ⅰ级者6例,Ⅱ级者22例,Ⅲ级者17例,总评分为(6.02±1.96)分,两位观察者间一致性好(Kappa=0.748,95%CI为0.000~0.076,P0.01)。MCTSI的评分Ⅰ级者1例,Ⅱ级者13例,Ⅲ级者31例,总评分为(7.91±2.11)分,两位观察者间一致性好(Kappa=0.788,95%CI为0.000~0.076,P0.01)。EPIC评分结果为:Ⅰ级者6例,Ⅱ级者11例,Ⅲ级者28例,总评分为(5.57±1.52)分,两位观察者间一致性好(Kappa=0.768,95%CI为0.000~0.076,P0.01)。CTSI、MCISI、EPIC评分分别与BISAP评分均呈正相关(rs=0.439,P=0.003;rs=0.640,P=0.000;rs=0.503,P=0.001)。结论胰腺炎三种CT评分与BISAP均趋于正相关,MCTSI和EPIC与BISAP相关性较好,且MCTSI与BISAP较EPIC与BISAP的相关性更好。     

APACHEⅡ,Ranson,Balthazar评估系统对重症急性胰腺炎诊断及预后评估的参考价值

目的分析APACHEⅡ、Ranson评分及Balthazar评分在预测重症急性胰腺炎(SAP)的病情严重度及治疗参考的应用价值。方法运用APACHEⅡ、Ranson及Balthazar评估系统对120例SAP患者的评分进行回顾性分析。结果APACHEⅡ评分在器官障碍组评分明显高于无器官障碍组(P<0.05),高分组器官障碍发生率高于低分组(P<0.05),死亡组评分高于存活组(P<0.05)。Ranson评分,有、无器官障碍及死亡组三者之间评分差异无统计学意义(P>0.05)。Balthazar分级及CTIS评分与临床预后密切相关,得分高的病死率显著上升(P<0.01)。结论APACHEⅡ、Ranson评分及Balthazar评分系统对判断病情及预后具有重要参考意义,Ranson价值有局限性,三种评分系统联合使用,对诊治及预后评估有指导意义。     

大黄辅助早期肠内营养在重症急性胰腺炎治疗中的作用：附37例报告

目的:探讨采用大黄辅助早期肠内营养(EEN)治疗重症急性胰腺炎(SAP)的疗效。方法:将127例SAP患者,分为大黄辅助EEN(EEN)组37例和大黄辅助中期肠内营养(MEN)组90例。观察两组:定量检测C-反应蛋白(CRP)和血清前白蛋白(PA),记录两组患者肠道功能恢复时间、器官损害数、感染部位数、胰腺假性囊肿数、病死率、住院时间、住院费用和APACHE-II评分等。结果:治疗12~14 d后,EEN组死亡2例(5.4%),MEN组死亡14例(15.6%);EEN组与MEN组比较,APACHE-II评分和CRP明显下降,而PA明显升高(P<0.05);EEN组患者的肠功能恢复时间、器官损害数、感染部位数、胰腺假性囊肿数、病死率、住院时间、住院费用均显著低于MEN组(P<0.05)。结论:大黄联合EEN治疗SAP,能促进患者肠功能恢复,改善患者的营养状况,减少并发症,缩短住院时间,降低医疗费用。     

超声引导下经皮穿刺置管引流在重症急性胰腺炎治疗价值的探讨:附57例报告

目的:探讨超声引导下经皮穿刺置管引流(PCD)在治疗重症急性胰腺炎急性液体积聚的应用价值。方法:回顾性分析1998年1月—2008年12月57例重症急性胰腺炎患者的临床资料进行回顾性分析,57例患者均有急性液体积聚,28例行超声引导下经皮穿刺置管引流治疗(引流治疗组),29例未穿刺引流行保守治疗(保守治疗组);两组患者在年龄,性别,CT严重指数(CTSI),APACHEⅡ评分等方面无统计学差异,具可比性。结果:引流治疗组与保守治疗组病死率比较,差异无统计学意义(P=1.000);引流治疗组与保守治疗组比较,胰腺假性囊肿的发生率低(P=0.033),住院时间短(P=0.002),中转手术率低(P=0.043)。结论:超声引导下经皮穿刺置管引流治疗重症急性胰腺炎可降低并发症,在治疗重症急性胰腺炎急性液体积聚有一定的治疗价值。     

Computed tomography severity index is a predictor of outcomes for severe pancreatitis

BACKGROUND: In a small group of patients with acute pancreatitis, Balthazar and Ranson demonstrated the applicability of computed tomography (CT) criteria to predict mortality. Building upon their work with a larger group of patients with acute pancreatitis, we set out not only to demonstrate that the CT severity index can predict death, but also length of hospital stay and need for necrosectomy. METHODS: We reviewed all patients admitted to our hospital in the years 1992 to 1997 with a primary diagnosis of acute pancreatitis. Entrance criteria required that a CT scan had been performed during the hospitalization. The index CT scan was used to determine a CT severity index (the CTSI of Balthazar and Ranson). Outcomes measured were death, length of stay (LOS), and need for necrosectomy (NEC). Statistical analysis was performed using Fisher's exact and chi-square tests where appropriate. RESULTS: Between the years 1992 to 1997, 886 patients had 1,774 admissions for acute pancreatitis, of which 268 had a CT scan performed and were entered into our study. These 268 patients had a mean age of 57 years, a mean LOS of 16 days (1 to 118), and a mean CTSI of 3.9 (0 to 10). Overall mortality was 4% (n = 11). A CTSI >5 significantly correlated with death (P = 0.0005), prolonged hospital stay (P <0.0001), and need for necrosectomy (P <0.0001). Patients with a CTSI >5 were 8 times more likely to die, 17 times more likely to have a prolonged hospital course, and 10 times more likely to undergo necrosectomy than their counterparts with CT scores <5. CONCLUSIONS: These data show that the CTSI is an applicable and comparable predictor of outcomes in severe pancreatitis.     

Correlation between admission laboratory values, early abdominal computed tomography, and severe complications of gallstone pancreatitis

BACKGROUND: Our previous study demonstrated that Balthazar grade D or E pancreatitis on early abdominal computed tomography (CT) scan correlated with severe complications of gallstone pancreatitis (GP).Objective: To compare the efficacy of individual admission laboratory criteria, multiple criteria scoring systems and CT scan for predicting severe complications of GP. METHODS: Consecutively admitted patients with GP underwent selective early CT scanning (<72 hours). All patients were prospectively monitored for severe complications. RESULTS: Of the 66 patients studied, 21 (32%) did not undergo for early CT scanning and underwent cholecystectomy with no complications. Forty-five patients (68%) had an early abdominal CT scan. Of the 12 patients with grade E pancreatitis, 6 (50%) developed severe complications versus only 2 of 33 (6%) with grade A to D pancreatitis (P = 0.002). A significant correlation was found between admission white blood cell count > or =14.5 x 10(9)/L and grade E pancreatitis on early CT scan (P = 0.002). However, admission glucose > or =150 mg/dL was the best predictor of complications (sensitivity 100%, negative predictive value 100%). CONCLUSION: Although Balthazar grade E on early CT scan correlates with severe complications of GP, admission glucose > or =150 mg/dL has a better sensitivity and negative predictive value, is quicker to use, and is more cost-effective as a prognostic indicator.     

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??The CT features of patients with abdominal compartment syndrome complicated by severe acute pancreatitis SUN Jia-kui*, LI Wei-qin, WANG Zhong-qiu, et al. *Medical School of Nanjing University, Institute of General Surgery, General Hospital of Nanjing Military Command, People’s Liberation Army, Nanjing 210002, China
Corresponding author??LI Wei-qin??E-mail: sunjiakui1985@163.com
Abstract Objective To evaluate the CT features and its’ clinical impact of abdominal compartment syndrome(ACS) complicated by severe acute pancreatitis(SAP). Methods A retrospective study was carried out on 23 cases of patients with ACS complicated by SAP admitted in our center from January 2008 to May 2011, to evaluate the CT features of ACS and its’ effect of assessing patients’ severity. Results The morbidity of ACS complicated by SAP in our center was 3.04%. In the 23 cases of patients, 12 cases was cured and 9 cases of them was cured by operation. The CTSI scores and the incidence of narrowing of inferior vena cava, elevation of the diaphragm, round belly sign was significant variable between the ACS and non-ACS patients. And the self-comparison of ACS patients showed that the incidence of narrowing of inferior vena cava, bowel wall thickening with contrast enhancement, elevation of the diaphragm was also significant variable. Among the seven CT features of ACS in previous articles, the frequency of those features had a significant variable in APACHEII??SOFA??MV days??CRRT days and mortality. Conclusions The CTSI scores and the incidence of narrowing of inferior vena cava, elevation of the diaphragm, round belly sign was significant variable between the ACS and non-ACS patients, and the frequency of CT features in previous articles also had a effect of assessing the ACS patients’ severity.     

CT检查预测急性胰腺炎局部并发症转归的价值

目的了解修订版亚特兰大分类标准下急性胰腺炎(AP)局部并发症的转归,探讨CT检查预测局部并发症转归的价值。方法回顾性分析2012年1月至2015年7月间163例急性胰周液体积聚(APFC)及84例急性坏死性积聚(ANC)患者的病历资料。28例APFC和41例ANC分别进展为胰腺假性囊肿(PP)和包裹性坏死(WON);19例患者合并局部感染。采用SPSS 17.0进行数据分析,比较PP组与APFC吸收组、WON组与ANC吸收组、局部并发症感染组与未感染组的组间差异。绘制受试者工作特征(ROC)曲线,判断其预测准确性。结果 PP组与APFC吸收组间积液分布范围、计算机断层扫描下胰周炎症(EPIC)评分有统计学差异;WON组与ANC吸收组间有差异的指标包括胰腺炎症部位、坏死累及胰腺、坏死面积、EPIC评分、计算机断层扫描严重指数(CTSI);感染组与未感染组间的肾前筋膜增厚、胰腺或胰周坏死、EPIC评分、CTSI有明显差异。积液分布范围预测APFC不吸收的准确性最高,EPIC评分预测ANC不吸收及局部并发症感染的准确性最高。结论大多数APFC自行吸收,约半数ANC自行吸收,局部并发症感染率较低。多个CT指标可用于预测局部并发症的转归。应重视EPIC评分的临床价值。     

Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis

Early diagnosis of severe acute pancreatitis (SAP) is important for the successful management of patients. Most scoring systems are complex or involve multiple parameters, which makes it difficult to ascertain the severity of acute pancreatitis at an early stage. Our study aims to evaluate the bedside index for severity in acute pancreatitis (BISAP) in predicting the severity of pancreatitis and mortality in a rural population, where financial constraints pose a major problem during treatment. We studied 55 patients of acute pancreatitis who presented to our institution between October 2014 and August 2016. The BISAP score was calculated within 24 h of admission. During the hospital stay, the CT severity index (CTSI) was calculated, and patients closely monitored to detect presence of organ failure or mortality. The accuracy of the BISAP and CTSI scores in predicting severity and mortality was determined by plotting receiver operating characteristic (ROC) curves, and calculating the area under curve (AUC). Sixteen (29%) patients developed persistent organ failure and were classified as severe acute pancreatitis (SAP), and four (7%) died. No patient with a BISAP score of 0 or 1 developed severe pancreatitis. The area under curve (AUC) for BISAP score in predicting severity and mortality was 0.902 and 0.958, respectively, better than that of CTSI. BISAP scores of 0 or 1 have a very high negative predictive value, and hence accurate for predicting mild disease. These patients can safely avoid a CT scan and the costs associated with it.     

重症胰腺炎病死原因分析:附144例

目的 分析重症急性胰腺炎(severe acute pancreatitis,SAP)的主要病死原因,提高诊治水平.方法 回顾性分析1997年6月至2006年5月收治的1162例SAP病人,其中病死144例(12.39%),放弃治疗82例(7.06%),痊愈936例(80.55%),对病死组与痊愈组的临床资料进行统计学分析.结果 病死组APACHEⅡ评分和胰腺Balthazar CT评分高于存活组;病死组单一器官功能不全、多器官功能障碍综合征(MODS)的百分率与存活组比较有统计学差异;无明显诱因的SAP病死率明显高于有诱因者.结论 中西医结合非手术疗法是治疗SAP可供选择的方法,无明显诱因的SAP是当前治疗的难题,胰腺的病变程度轻重及全身情况好坏是影响SAP病死率的首要原因,早期诊断和治疗是降低其病死率的关键,维护重要器官功能的是其疗效的根本保障.     

中度急性胰腺炎临床特征分析

目的探讨中度急性胰腺炎的临床特征。方法回顾性分析2013年1月至12月,青海省交通医院普通外科收治的103例急性胰腺炎（acute pancreatitis,AP）患者临床资料,根据国际AP专题研讨会最新修订的诊断和分类标准（2012年,美国亚特兰大）诊断为轻度急性胰腺炎（mildacutepancreatitis,MAP）61例、中度急性胰腺炎（moderately severe acute pancreatitis,MSAP）25例、重度急性胰腺炎（severe acute pancreatitis,SAP）17例,对比三组患者一般资料、局部并发症发生此例、器官功能衰竭发生比例、入住ICU比例和天数、干预措施、住院天数、病死率。结果三组患者性别、年龄和病因学情况差异均无统计学意义,但MSAP组APACHEⅡ评分显著高于MAP组,同时低于SAP组（均P〈0．05）。MAP、MSAP和SAP三组出现局部并发症的比例分别为0、92．0％（23125）和76．5％（13／17）（P〈0．05）。MAP组无器官功能表竭发生,MSAP组5例出现一过性（〈48h）器官功能表竭,SAP组均出观特续性（〉48h）器官功能衰竭,SAP组器官功能衰竭比例显著高于MSAP组（P〈0．05）。MAP组无入住ICU病例,均无需介入、内镜或外科干预,无死亡病例。MSAP组入住ICU此例、ICU时间、住院时间和病死率显著低于SAP组（P〈0．05）。结论中度急性胰腺炎为有别于轻度和重度急性胰腺炎的独立类型,伴有局部并发症或一过性（48h内）器官功能表竭,但病死率较低,预后明显好于重度急性胰腺炎。     

早期肠屏障功能保护在重症急性胰腺炎治疗中的重要性

目的 观察早期保护肠屏障功能对重症急性胰腺炎(SAP)患者的影响.方法 分析56例SAP患者的治疗方法和预后.随机数字表法将患者分为常规治疗组(A组)和肠屏障保护组(B组),比较两组患者不同时间的APACHEⅡ评分、Ranson评分、Marshall评分、CT严重指数(CTSI)、胃肠功能评分、尿乳果糖/甘露醇(L/M)比值、血浆内毒素和二胺氧化酶(DAO)、血清C反应蛋白(CRP)和肿瘤坏死因子α(TNF-α)、胰腺感染和多器官功能障碍综合征(MODS)发生率、住院病死率.结果 治疗后第7天,B组APACHEⅡ评分、胃肠功能评分、尿L/M比值、血浆内毒素和DAO、血清CRP和TNF-α较A组显著降低,差异有统计学意义(P<0.05).入院2周内,两组患者CTSI比较,差异无统计学意义(P>0.05);B组患者胰腺感染和MODS发生率明显低于A组,差异有统计学意义(P<0.05);两组住院病死率比较,差异无统计学意义(P>0.05).结论 早期保护肠屏障功能,能明显减轻SAP患者的全身炎症反应,降低胰腺感染和MODS发生率,从而改善其预后.

Abstract：

Objective To observe the influence of early intestinal barrier protection in patients with severe acute pancreatitis(SAP). Methods To analyze the therapeutic methods and prognosis of 56 patients with SAP. The patients were randomly divided into the conventional therapy group (A) and the intestinal barrier protection group (B). The APACHE Ⅱ score, Ranson score, Marshall score, CT severity index (CTSI), gastrointestinal functions score (GFS), the ratio of Lactulose to Mannitol (L/M), plasma Endotoxin and Diamine Oxidase (DAO), serum C-reactive protein (CRP) and TNF-α, incidence of pancreatic infection and multiorgan dysfunction syndrome (MODS), and the hospitalization mortality were compared between the two groups. Results On the 7th day after admission, the APACHE Ⅱ score, GFS, L/M, Endotoxin, DAO, CRP and TNF-α were significantly less in group B than in group A (P<0. 05). There was no significant difference in the CTSI (P>0. 05)between the two groups at 2nd week after admission. The incidence of pancreatic infection and MODS in group B were significantly lower than in group A (P<0. 05). The hospitalization mortality was not significantly different (P>0. 05) between the two groups. Conclusion Early intestinal barrier protection in SAP alleviated systemic inflammatory response, and reduced the incidences of pancreatic infection and MODS, thus improved the prognosis.     

暴发性急性胰腺炎的诊断与治疗

With the unremitting efforts of researchers for the past 40 years, the survival of patients with severe acute pancreatitis (SAP) has been improved to 86%. Patients with SAP, although had been given fluid resuscitation and formal non-operative therapy in 72 hours after the onset, still progress to organ dysfunction can be diagnosed with fulminant acute pancreatitis (FAP). The treatment methods for FAP include sufficient fluid resuscitation, formal non-operative therapy and removing etiological factors. If patients have the tendency toward deterioration of organ function or incidence of abdominal compartment syndrome (ACS), creating conditions for early surgical drainage is essential, and the surgical procedure should be as simple as possible. The survival rate of patients with FAP is still unsatisfactory, and the advanced age, high scores of acute physiology and chronic health enquiry ( APACHE Ⅱ ), sequential organ failure assessment (SOFA) and Balthazar, and the incidence of ACS are the indicators for a poor prognosis of patients with FAP.