ObjectiveTo investigate correlation of bedside index for severity in acute pancreatitis(BISAP) and computed tomography severity index(CTSI), modified computed tomography severity index(MCTSI), or extra-pancreatic inflammation on CT(EPIC) score, respectively, in assessing severity of acute pancreatitis. MethodsForty-five patients confirmed SAP from July 2015 to November 2015 in West China Hospital of Sichuan University were prospectively included into this study. Contrast-enhanced multi-detector-row CT scan was performed for all the patients. The abnormal imaging features, such as pancreatic and peri-pancreatic inflammatory changes, involvement of other organs and local complications, were observed and used to calculate three CT severity indexes(CTSI, MCTSI, and EPIC). The clinical data were also colle-cted to calculate BISAP and as compared with CT severity indexes. Correlation between the CT indexes points and BISAP score was estimated using the Spearman test. Interobserver agreement for CTSI, MCTSI or EPIC was calculated using the Kappa statistic. ResultsThe results of BISAP score were as follows: 4 cases gradeⅠ, 22 cases gradeⅡ, 19 cases gradeⅢ. The results of CTSI score were as follows: 6 cases gradeⅠ, 22 cases gradeⅡ, 17 cases gradeⅢ. The results of MCTSI score were as follows: 1 case gradeⅠ, 13 cases gradeⅡ, 31 cases gradeⅢ. The results of EPIC score were as follows: 6 cases gradeⅠ, 11 cases gradeⅡ, 28 cases gradeⅢ. The score of BISAP, CTSI, MCIST, or EPIC was 2.41±0.82, 6.02±1.96, 7.91± 2.11, and 5.57±1.52, respectively. Interobserver agreements for CTSI, MCTSI, and EPIC were good(CTSI: Kappa=0.748, 95% CI 0.000-0.076, P < 0.01; MCTSI: Kappa=0.788, 95% CI 0.000-0.076, P < 0.01; EPIC: Kappa=0.768, 95% CI 0.000-0.076, P < 0.01). Spearman statistic showed there was a positive correlation between CTSI score(rs=0.439, P=0.003), MCTSI score(rs=0.640, P=0.000), or EPIC(rs=0.503, P=0.001) and BISAP score. ConclusionThere is a positive correlation between MCTSI or EPIC and BISAP score, and MCTSI is more strongly correlated with BISAP as compared with EPIC.
Objective To explore the effect of early enteral nutrition in the clinical treatment of severe acute pancreatitis (SAP). Methods Forty-two SAP patients who improved with non-surgical treatments between January 2012 and December 2014 were selected and randomly divided into control group and study group with 21 patients in each. Patients in the control group accepted whole venous nutrition, while those in the study group had early enteral nutrition. Nutrition indexes, blood biological indexes, and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score on day 7 and 14 after treatment, and average hospital stay of the two groups of patients were recorded and compared. Results No differences in body weight reduction, lymphocytes, serum albumin, calcium, glucose, APACHE Ⅱ score between the two groups after 7 days of treatment were observed (P>0.05). But there were significant differences in body weight, lymphocytes, serum albumin, and APACHE Ⅱ score between these two groups after 14 days of treatment (P<0.05). Hospital stay of the study group was obviously shorter (P<0.01). Conclusions Early enteral nutrition support for patients with severe acute pancreatitis can improve nutritional status and shorten hospital stay. It is worthy of wider clinical application.
ObjectiveTo summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis. MethodsThe clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group). ResultsThe APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05). ConclusionThe combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.
ObjectiveTo explore the effect of the serum high mobility group box-1 (HMGB1) on oncosis of pancreatic acinar cells in the rat with severe acute pancreatitis (SAP). MethodsThirty-two healthy SD rats were randomly divided into 2 groups:sham operation group (SO group, n=8) and SAP group (n=24). Rats of SO group were only flipped the intestinal canal after laparotomy, but rats of SAP group were induced by retrograde injection of 3% sodium taurocholate into bilio-pancreatic duct in addition. Rats of SO group were sacrificed at 6 hours after operation, and rats of SAP group were sacrificed at 6 (SAP-6 hour group, n=8), 12 (SAP-12 hour group, n=8), and 24 hours (SAP-24 hour group, n=8) after operation respectively. Pancreatic tissues were stained by HE to observe pathological changes. Serum HMGB1 was measured by ELISA, and the oncosis percentage of pancreatic acinar cells was examined by flowcytometry. ResultsPathological results showed that structural integrity was observed in pancreatic acinar, and occasionally a single inflammatory cell infiltration was observed in rats of SO group. Swelling, interstitial edema, and inflammatory cell infiltration were observed in rats of SAP-6 hour group. Some necrosis of pancreatic acinar cell, stromal vascular congestion, and focal necrosis were observed in rats of SAP-12 hour group and SAP-24 hour group, which the pathological damage were worse over time. Levels of serum HMGB1 and oncosis percentages of pancreatic acinar cells in rats of 3 SAP subgroups were all higher than those of SO group (P < 0.01), and the 2 kinds of indexes both increased over time (P < 0.05). There was positive correlation between concentration of serum HMGB1 and oncosis percentages of pancreatic acinar cells in SAP rat during 24 hours after operation (r=0.846, P < 0.01). ConclusionsHMGB1 seems to play an important role in SAP by inducing oncosis of pancreatic acinar cells when inducing inflammatory reaction in rat with SAP.
ObjectiveTo observe the effects and mechanism of MCP-1 in ileum and pancreatic tissues in rats with severe acute pancreatitis(SAP). MethodsTwenty-fourth healthy SD rats were randomly divided into two groups:control group(n=12) and SAP model group(n=12). SAP was induced in model group by retrograde injection of 3% sodium taucrocholate into the biliopancreatic duct of rats. The control group underwent laparotomy with the manipulation of the intestinal canal. The rats were killed at 12 h and 24 h respectively after operation, blood and tissue samples were collected to detect the indexes as follows:①Expressions of MCP-1 mRNA of pancreatic and ileum tissues were detected by RT-PCR; ②blood plasma MCP-1 and IL-10 levels were detected by ELISA; ③blood plasma AMY and DAO levels were detected by colorimetry; ④the pathological changes of pancreas and ileum tissues were observed. ResultsCompared with the control group, the levels of MCP-1, IL-10, AMY, and DAO in plasma, pancreas, and ileum tissues were significantly increased in SAP model group(P < 0.01), the expressions of MCP-1 mRNA in pancreas and ileum tissues were up-regulated simultaneously(P < 0.01), and pathological scoring increased obviously(P < 0.01). ConclusionThe levels of MCP-1 in plasma, pancreas and ileum tissues are significantly increased in rats with SAP, MCP-1 aggravate the injury of pancreas and ileum tissues.
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 explore the effects of ulinastatin (UTI) on renal apoptosis and expression of bcl-2 in rats with severe acute pancreatitis (SAP). Methods Sixty rats weighing 250-300 g were randomized divided into 3 groups: pseudo-operation group (SO group, n=20), SAP group (n=20) and UTI treated group (UTI group, n=20). The model of SAP was established by retrograde injection of 5% sodium taurocholate solution into the biliopancreatic duct in the rats. Serum Cr and BUN were determined. The left kidneys were resected for light and electronic microscopic study. Renal cell apoptosis was determined by TUNEL. Expression of bcl-2 was detected by immunohistochemical staining of SABC. Results Serum Cr, BUN, renal cell apoptotic index and bcl-2 expression were markedly increased in SAP group compared with SO group （P＜0.05， P＜0.01）, Renal tissue injuries were aggravated in SAP group under light and electronic microscopic study as well. In UTI group, serum Cr, BUN and renal cell apoptotic index were decreased significantly while the expression of bcl-2 increased remarkably and renal tissue injuries relieved compared with SAP group （P＜0.05）. Positive correlations were found between the renal cell apoptotic index and BUN as well as Cr (r=0.807, P＜0.05; r=0.812, P＜0.05). Conclusion The protective effect of UTI on SAP renal injury is probably through increasing bcl-2 expression and decreasing apoptosis.
Objective To evaluate and summarize the relevant evidence of early enteral nutrition in patients with severe acute pancreatitis (SAP), and provide evidence-based support for the clinical practice of early enteral nutrition in SAP patients. Methods The evidence on early enteral nutrition in SAP patients from relevant databases and websites was retrieved using computer. The retrieval deadline was from the establishment of the databases to December 31, 2024. Two researchers independently conducted literature screening and quality evaluation, extracted and summarized evidence. Results A total of 14 articles were included, including 6 systematic reviews, 7 guidelines, and 1 expert consensus. A total of 19 pieces of evidence were compiled and summarized from 9 aspects, including early enteral nutrition feeding assessment, start timing, feeding route, catheterization method, infusion method and speed, energy and protein targets, nutrient preparation selection, complication prevention and management, and health education. Conclusion The overall quality of evidence for early enteral nutrition in SAP patients is good and has strong generalizability. Medical staff should select evidence based on clinical contexts and develop safe, scientific, and personalized enteral nutrition plans for patients to promote their recovery.
Objective To explore the value of CT guided percutaneous puncture, aspiration and drainage on diagnosis and treatment of local complications of severe acute pancreatitis (SAP). Methods Forty-three cases of SAP combined with pancreatic necrosis, peripancreatic hydrops, pseudocyst and abscess were analyzed, all of them underwent CT guided percutaneous puncture, aspiration and drainage. Results The punctures were performed on 43 SAP patients for sixty-four times, the success rate was 100%, and in 24 cases of them puncture were performed for diagnosis, the positive rate of fluid absorption by puncture was 100%. Forty-one of 43 cases (95%) received puncture and tube drainage, open operation was performed in one patient, one patient was automatically discharged. The remission rate of abdominal distension was 93% (40/43) and 16 of 43 cases (37%) were turned to open operation. The effective rate of drainage was 61% (25/41). Conclusion The puncture, aspiration and drainage guided by CT is an effective method in diagnosis and treatment of local complications in part of SAP cases.
Objective To investigate the mechanism of gastrointestinal motility disorder of severe acute pancreatitis （SAP） in rats. Methods SD rats were randomly divided into 2 groups：sham operation （SO） group （n=16） and SAP group （n=16）. The gastric antrum interdigestive myoelectric complex （IMC） of rat was recorded by using bipolar silver electrode recording， the concentration of serum motilin （MTL） and vasoactive intestinal peptide （VIP） were detected by enzyme-linked immunosorbent assay （ELISA） method， and determined the pancreatic pathology score. Results Compared with SO group， the concentration of serum MTL obvious decreased and the concentration of VIP obvious rised in SAP group （P＜0.01）. Compared with SO group， the time of IMC cycle， andⅠand Ⅱ phase were extended， and time of Ⅲ phase was shortened， also the amplitude and frequency of peak electric of Ⅲ phase were declined in SAP group （P＜0.01）. And the concentration of MTL in SAP group showed positive correlation with the time of Ⅲ phase of IMC （r=0.967， P＜0.01）， the concentration of VIP in SAP group showed negative correlation with the time of Ⅲ phase of IMC （r=-0.592， P＜0.05）. The pancreatic organization pathological score in SAP group was higher than that in SO group （P＜0.01）. Conclusion There is gastrointestinal motility disorder in SAP rats， furthermore， it may induce gastrointestinal motility disorder through effecting the gastrointestinal smooth muscle electrical activity.