特重型急性胰腺炎救治措施探讨(附一例报告)

目的：探讨特重型（暴发性）急性胰腺炎的合理救治方案。病人与方法：一例特重型急性胰腺炎患者，因２４小时监护治疗中病情迅速恶化，而行早期手术，继而采用短时血滤、多脏器监护、综合支持治疗和再次清创治疗。结果：经早期手术引流，生命体征迅速改善；经短时血滤、负水平衡和短程激素治疗，毛细血管渗漏得以控制，内稳态恢复；并发坏死感染首先表现为呼吸机参数和胰岛素用量增加，坏死感染灶经ＣＴ证实后被及时清除；并发十二指肠溃烂断离，经结肠下胃空肠吻合及十二指肠造瘘而治愈；并发中毒性心肌炎，经清除膈下感染坏死灶和采用抗致命性心律失常、强心、心肌营养等药物而治愈。患者经１４６天住院治疗痊愈出院。结论：合理而及时的手术治疗、阻断病情加重因素、治疗毛细血管渗漏及尽早肠内营养是特重型急性胰腺炎的重要治疗措施。

Therapeutic Strategy in Fulminant Acute Pancreatitis(Report of One Case)

To investigate the therapeutic strategy of fulminant acute pancreatitis. Patient and Method: A case of fulminant acute pancreatitis underwent early operation due to deteriorating general condition after a 24 hour period of intensive supportive therapy. Short time veno-venous hemofiltration, multiple organ monitoring, comprehensive supportive therapy and repeated debridement were consecutively adopted. Results: The vital signs were rapidly improved after early operative drainage. Capillary leakage was controlled and homeostasis re-established after veno-venous hemofiltration, limitation in fluid infusion and short-term administration of steroid. Subsequent formation of infected necrotic fool, manifested as alterations in ventilator parameters and increased demand for insulin, was consequently confirmed by CT scan and treated by repeated debridement. Duodenal stress ulcer which caused by erosion and disconnection of almost the whole circumference was treated by infra-colic gastrojejunostomy and duodenostomy. Toxic myocarditis was managed by debridement of subdiaphragmic infected necrotic focus, treatment of lethal arrhythmia, by meams of inotropic, vasodilator and myocardiotrophic agents. The patient was discharged in good health after 146 days of hospital stay. Conclusions: An appropriate combination of timely surgical intervention, blocking of deteriorating factors, control of capillary leakage and early enteral nutritional su pport contributed to the favorable outcome of the case reported here-in.