重症急性胰腺炎病人器官功能支持  

Multiple organ support therapy for severe acute pancreatitis

作　　者：马晓春[1] 栾正刚[1] 

机构地区：[1]中国医科大学附属第一医院重症医学科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2012年第7期530-533,共4页Chinese Journal of Practical Surgery

摘　　要：胰腺炎病人原则上应住院接受治疗,需密切监测病人的意识状态、心肺功能及尿量的变化,给予充分的液体复苏和镇痛等,同时要进行病因学评估和疾病严重性评估。对于重症急性胰腺炎病人应进入重症医学科治疗,接受器官功能监护、血液净化以及营养支持等。胰腺炎诊断48 h内应反复评估病情的严重程度,参考血流动力学指标的变化,给予病人充分的液体复苏,恢复血流动力学稳定。重症急性胰腺炎病人在行液体复苏时,通常需要大量的液体才能稳定病人的血流动力学指标。为防治重症急性胰腺炎病人的感染性并发症,建议预防性应用抗生素。为防治器官功能障碍和其他并发症,可应用大剂量的合成蛋白酶抑制剂。重症急性胰腺炎病人的营养支持应首选肠内营养。对于重症急性胰腺炎病人,可选择应用持续动脉灌注治疗和持续血液净化治疗。Patients with acute pancreatitis should be hospitalized on principle. Crucial fundamental managements are required soon after a diagnosis of acute pancreatitis has been made and including monitoring of the conscious state, the respiratory and cardiovascular system, the urinary output, adequate fluid replacement and pain control. Along with such managements, etiologic diagnosis and severity assessment should be conducted. Patients with a diagnosis of severe acute pancreatitis （SAP） should be transferred to ICU where intensive respiratory and cardiovascular management as well as interventional treatment, blood purification therapy and nutritional support are available. Severity assessment should be conducted repeatedly at least within 48 h following diagnosis. An adequate dose of fluid replacement is essential to stabilize cardiovascular dynamics and the dose should be adjusted while assessing circulatory dynamics constantly. A large dose of fluid replacement is usually required in patients with SAP. Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with SAP. Although the efficacy of intravenous administration of protease inhibitors is still a matter of controversy, there is a consensus that a large dose of a synthetic protease inhibitor should be given to patients with SAP in order to prevent organ failure and other complications. Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with SAP. Continuous artery infusion and continuous blood purification can be used selectively for SAP.

关 键 词：重症急性胰腺炎 营养支持 蛋白酶抑制剂 

分 类 号：R6[医药卫生—外科学]