【Abstract】Objective To summarize the effects of vasoactive mediators on local microvasculature in acute pancreatitis（AP）. Methods Literatures concerning metabolism, receptors, action mechanisms of vasoactive mediators and their effects in AP were reviewed. Results Bradykinin, endothelin, platelet activating factor and nitric oxide were important mediators in the development of microcirculatory disturbance in AP, however the results of experiments were inconsistent. Conclusion The roles which vasoactive mediators play in microcirculatory disturbance of AP are affected by many factors, and await further study.
目的:探讨合理的营养支持方式对重症急性胰腺炎(SAP)患者营养状况及预后的影响。方法:将60例SAP患者随机分为全胃肠外营养支持(对照组)和肠内与肠外相结合营养支持(实验组)两组,对比营养支持前后两组患者的血红蛋白、总蛋白、血清白蛋白、氮平衡、血脂等生化指标,每天观察相关并发症情况。结果:实验组血清白蛋白、总蛋白、血红蛋白、氮平衡方面明显优于对照组(Plt;0.05),且并发症少。结论:肠内与肠外结合的营养支持方式可以改善SAP患者的营养状况,对SAP患者治疗有积极的作用。
【Abstract】Objective To investigate the protective effect of improving the pancreatic ischemia and calcium channel blockers on preventing the progression of acute pancreatitis. Methods Twenty-four patients with mild acute pancreatitis were randomly divided into two groups： control group and treated group. Within the first 72 hours from the onset of AP, routine conservative managements were performed in control group, improving the pancreatic ischemia and preventing Ca2+ overload were performed in treated group for two weeks. The hemorrheological parameters were measured at 1,4,7,14 days after adimission, simultanously, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were determined with ELISA methods. Results The hemorrheological changes were improved in treated group, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were significantly decreased each time point in treated group as compared with control group. Conclusion Improving the pancreatic ischemia and calcium channel blockers have protective effect through reducing the generation of cytokines and inflammatory mediators on preventing the progression of acute pancreatitis.
Objective To investigate the relationship between early fluid management and the conversion rate to surgery in patients with sever acute pancreatitis( SAP) .Methods The patients with SAP admitted in ICU in West China Hospital from July 2005 to June 2010 were retrospectively analyzed. They were divided into four groups according to the quartile of the accumulated fluid balance in the first three days after admission in ICU( lt; 25% , 25% ～50% , 50% ～75% , and gt; 75% , respectively) . The major demographic data, clinical characteristics, mortality, and conversion rate to surgery were evaluated respectively. Results 208 patients were enrolled. For each quartile, the conversion rate to surgery decreased at first, and then increased along with the increase of the accumulated fluid balance. Significant difference existed between the second quartile with the lowest conversion rate to surgery and other three quartiles ( P lt; 0. 05) . Differences were also found in mortality and the score of acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) on 24th and 48th hour between the first three quartiles and the last quartile with the highest mortality and APACHⅡ score( P lt;0. 05) . However, sex ratio, age, Ranson criteria, and the score of sequential organ failure assessment( SOFA) did not have significant differences among each quartile( P gt; 0. 05) . Conclusion Fluid management in early stage can influence conversion rate to surgery and mortality in patients with SAP.
To investigate changes of serum nitric oxide (NO) levels and therapeutic effects of sodium nitroprusside (SNP) in acute hemorrhagic necrotizing pancreatitis (AHNP) in rats, one hundred and twenty Wistar rats were divided into three groups randomly (forty in each group) animal models of AHNP group were produced by retrograde injection of 5% sodium taurocholate into pancreatobiliary duct.In the treatment group SNP (0.05mg/100g) was injected intraperitoneally after AHNP models established and then repeated three hours later. In the control group only retrograde injection of normal saline (0.5ml) into pancreatobiliary duct was performed. The results showed: compared with the treatment group, serum NO and SOD levels were significantly lower in AHNP group (Ｐ＜0.05); serum amylase levels and pancreatic indexes were markedly higher in AHNP (Ｐ＜0.01 and Ｐ＜0.05 respectively);the mortality in 24 hours was significantly higher and survival time was significantly shorter in AHNP group (Ｐ＜0.01).Pathologic changes of pancreas were significantly severe in AHNP group. From the above results we can draw the conclusion that NO plays an important role in the pathogenesis of AHNP and SNP has therapeutic effects on AHNP in rats.
摘要:目的:探讨重症急性胰腺炎(SAP)继发感染的临床特点。方法:将我院20039~20053收治的SAP140例,按是否感染,分成感染组和对照组,对比分析其临床资料。结果:感染组病死率高于对照组(P=0023);感染组入院初期,Ranson评分、CT评分、APACHE Ⅱ评分、血糖、ARDS和肠麻痹发生率、感染前手术率及呼吸机辅助呼吸率高于对照组(Plt;005);以G感染胰腺、胰周围及肺部为主;肺部感染时间为107±25d,胰腺或胰周为176±29d。结论:急性期全身反应轻重及胰腺坏死程度是SAP继发感染的基础;临床有创治疗措施是促进因素。
Objective To evaluate the effect of early clinical interference strategies on preventing the conversion of acute pancreatitis to the severe form and aggravation of severe acute pancreatitis (SAP). Methods The patients with acute pancreatitis admitted to this hospital were divided into two therapeutic phases by different therapeutic methods from January 2001 to December 2008. Patients in the first phase (from January 2001 to December 2004) were treated by the routine management, and the second phase (from January 2005 to December 2008) by the routine management combined with early clinical interference strategies. Then, the ratio of conversion from acute pancreatitis to SAP and prognosis of SAP between two phases were compared. Results Compared with the first phase, the rate of aggravation of acute pancreatitis was significantly decreased in the second phase (4.48% vs. 21.18%), the average healing time of SAP, the incidences of systemic and local complications and the mortality of pancreatitis were reduced (P＜0.05). When early clinical interference strategies were performed, some adverse reaction and complications occurred in 35 cases, but without severe consequence. Conclusion Early clinical interference strategies may serve as a beneficial strategy on preventing the progression of mild acute pancreatitis to the severe form or halting the aggravation of acute pancreatitis.
Objective To investigate the mechanism of radix salviae miltiorrhizae (RSM) injection in treatment of pancreatitis through observing the changes of activity of nuclear factor-kappa B (NF-κB) in pancreas of rats with severe acute pancreatitis (SAP) and the influence of RSM injection upon NF-κB in pancreas tissue. Methods Seventy-five rats were randomly divided into 3 groups: normal control group, SAP group and RSM treatment group, which were injected with normal saline, normal saline or RSM in the peritoneal cavity, respectively. The model of SAP rats was made by injecting L-arginine into peritoneal cavity and by subcutaneous injection at the same time. The concentrations of amylase in plasma and in ascites were measured respectively, and the expression of NF-κB in pancreas tissues was determined by immunohistochemistry. Results The levels of amylase in plasm and ascites in SAP group and RSM treatment group increased significantly with the increased expression of NF-κB in pancreas tissue, but it was also found that both the level of amylase and the expression of NF-κB in RSM treatment group were significantly lower compared with those in SAP group, and the survival time of RSM treatment group was longer than SAP group with less pathological injury in the pancreas tissues. Conclusion RSM may be effective for the treatment of pancreatitis by degrading the expression of NF-κB.