Objective To investigate the efficiency of combining traditional Chinese medicine with western medicine in the treatment of severe acute pancreatitis (SAP). Methods The clinical results of sixty three cases of SAP of non-operative treatment with injection of Salia miltorrhizae composita, and oral or gastric tube feeding of decoction Qing-Yi-Tang were retrospectively studied. Results Thirty four cases were categorised as SAP Ⅰ grade, and 29 cases as SAP Ⅱ grade. A variety of complications occurred in 19 cases (30.16%), 3 patients died (4.76%), and 4 patients developing abscess of pancreas (6.35%) which had to be operated on.Conclusion The individualization principle on the basis of cause and clinical stage of the disease should be stressed in treating SAP. The patients who had complication needing to be operated on should be timely performed. There is a good efficiency in the treatment of SAP with the traditional Chinese medicine combining with western medicine.
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.
【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.
【Abstract】Objective To investigate the role of early surgical intervention in the treatment of fulminant acute pancreatitis (FAP).Methods Eight cases of FAP admitted to our institution from September 2003 to December 2004 were reviewed retrospectively.Results Averagely 3 organs dysfunction was diagnosed on admission or in the course of treatment in this group. One patient treated non-operatively was dead. Of 7 cases with early surgical intervention, one was died of ACS and ARF, One female patient with 32 weeks pregnancy survived, but the fetus was dead before surgery. Five cases were complicated with intra-abscess, which were cured re-operatively. Conclusion Early operative intervention in the treatment of FAP could prevent MODS and improve the survival.
摘要:目的：探讨急性重症胰腺炎（SAP）早期不同种类液体复苏对其预后的影响。方法：应用随机对照的方法,分别对2007年12月~2009年10月同期入院的48例SAP患者,随机分成两组,试验组和对照组。试验组第一周内液体复苏采用晶体液和人工胶体（羟乙基淀粉）,对照组采用晶体液,其他治疗方法不变。然后统计其第一周死亡率、ARDS、多器官功能障碍综合征（MODS）发生率,对比两组患者呼吸频率、血氧饱和度和红细胞压积（HCT）差异,以及两组患者肠功能恢复时间、住院时间以及并发症发生率。结果：试验组的液体复苏较对照组显著改善SAP的各项指标（P＜005）。血清乳酸水平（15±05）mmol/L,红细胞压积(HCT)为（324±69）%,ScvO2为（817±152）%,病死率83%,MODS发生率333%,〖HT5”H〗结论:〖HT5”SS〗 SAP早期联合应用晶胶体进行液体复苏可有效恢复循环血容量和防止体液潴留,显著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.
Ａ ｒｅｖｉｅｗ ｏｆ ｐａｔｉｅｎｔｓ ｗｉｔｈ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ ｔｒｅａｔｅｄ ｉｎ ｔｈｉｓ ｈｏｓｐｉｔａｌ ｉｎ ｒｅｃｅｎｔ １０ ｙｅａｒｓ ｗａｓ ｍａｄｅ．Ｔｏ ｄｅｔｅｒｍｉｎｅ ｔｈｅ ｒｉｓｋ ｆａｃｔｏｒｓ ｏｆ ｓｅｐｔｉｃ ｎｅｃｒｏｓｉｓ ｉｎ ａｎｄ ａｒｏｕｎｄ ｔｈｅ ｐａｎｃｒｅａｓ，３２ ｃａｓｅｓ ｗｉｔｈ ｓｅｐｔｉｃ ｎｅｃｒｏｓｉｓ ｗｈｉｃｈ ｗｅｒｅ ｐｒｏｖｅｄ ｉｎ ｓｕｒｇｉｃａｌ ｏｐｅｒａｔｉｏｎ ａｎｄ ４４ ｃａｓｅｓ ｗｉｔｈｏｕｔ ｓｅｐｔｉｃ ｎｅｃｒｏｓｉｓ（ａｓ ｃｏｎｔｒｏｌ）ｗｅｒｅ ｉｎｃｌｕｄｅｄ ｉｎ ｔｈｉｓ ｓｔｕｄｙ．Ｔｈｅ ｐｏｓｓｉｂｌｅ ｆａｃｔｏｒｓ ｗｅｒｅ ｃｏｍｐａｒａｔｉｖｅｌｙ ａｎａｌｙｓｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｓｅｐｔｉｃ ｎｅｃｒｏｓｉｓ ｉｎ ａｎｄ ａｒｏｕｎｄ ｔｈｅ ｐａｎｃｒｅａｓ ｏｂｖｉｏｕｓｌｙ ｒｅｌａｔｅｄ ｔｏ ｔｈｅ ｄｉａｇｎｏｓｔｉｃ ｏｒ ｔｈｅｒａｐｅｕｔｉｃ ｐｕｎｃｔｕｒｅｓ，ｅａｒｌｙ ｓｕｒｇｉｃａｌ ｄｒａｉｎａｇｅ ａｎｄ ｐａｒａｌｙｔｉｃ ｉｌｅｕｓ（ＯＲ ３０２－５４８，Ｐ＜００５)，ｂｕｔ ｔｈｅｒｅ ｗｅｒｅ ｎｏ ａｓｓｏｃｉａｔｉｏｎｓ ｗｉｔｈ ａｇｅ，ｅｔｉｏｌｏｇｙ，ｓｈｏｃｋ，ｒｅｓｐｉｒａｔｏｒｙ ｆａｉｌｕｒｅ ａｎｄ ｔｏｔａｌ ｐａｒｅｎｔｅｒａｌ ｎｕｔｒｉｔｉｏｎ（ＯＲ ０７８－１２６，Ｐ＞００５）．Ｔｈｅ ａｕｔｈｅｒｓ ｓｕｇｇｅｓｔ ｔｈａｔ ｅｉｔｈｅｒ ｐａｎｃｒｅａｔｉｃ，ｐｅｒｉｐａｎｃｒｅａｔｉｃ ｐｕｎｃｔｕｒｅ ｏｒ ｅａｒｌｙ ｓｕｒｇｉｃａｌ ｄｒａｉｎａｇｅ ｓｈｏｕｌｄ ｂｅ ｌｉｍｉｔｅｄ ａｎｄ ａｎｙ ｍｅｄｉｃａｔｉｏｎ ｗｈｉｃｈ ｍａｋｅｓ ｐａｒａｌｙｔｉｃ ｉｌｅｕｓ ｄｅｔｅｒｉｏｒａｔｅｄ ｓｕｃｈ ａｓ ａｔｒｏｐｉｎｅ ｓｈｏｕｌｄ ｂｅ ａｖｏｉｄｅｄ ｉｎ ｔｈｅ ｔｒｅａｔｍｅｎｔ ｏｆ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ．
目的:探讨急性胰腺炎的胸腹部X线平片显示特征及诊断。方法:回顾分析19例急性重症胰腺炎的胸腹部X线平片资料,总结其影像特征。结果:急性胰腺炎胸腹部X线平片显示反射性肠郁积15例,十二指肠曲部见弧形压迹1例, 剑突下胰腺区高密度影1例,麻痹性肠梗阻伴胸腔积液2例。结论:胸腹部X线平片经济,快捷,在急性胰腺炎早期诊断中有一定价值。