重症急性胰腺炎早期保守治疗的关键点  

Key points of early conservative treatment of acute severe pancreatitis

作　　者：唐历 刘施材 王政强 赖大年 

机构地区：[1]长安医院普外科,陕西西安710016

出　　处：《同济大学学报（医学版）》2015年第4期101-103,共3页Journal of Tongji University(Medical Science)

摘　　要：目的探讨重症急性胰腺炎临床特点、早期治疗流程和保守治疗关键点。方法回顾性分析西安长安医院普外科2009年9月至2014年9月收治61例重症急性胰腺炎患者临床资料,排除临床资料不全及入院后3 d内自动出院者。结果 61例入组分析,其中男41例,女20例;年龄18～78岁（平均43岁）。治疗中死亡3例,发病2周因胰周积液形成脓肿中转手术引流2例,结石梗阻引起黄疸加重行胆道引流术3例,胰腺周围假性囊肿形成16例（其中6例于发病后3～6个月行囊肿内引流手术）,其余37例经4～6周保守治疗后痊愈。结论重症急性胰腺炎,早期治疗的关键点为：快速液体复苏,纠正低血容量休克;尽早用通便灌肠法（中药汤）减少肠内容物、降低肠道内压力进而降低腹内压;芒硝及中药药渣外敷腹部以减轻腹腔、胰周组织水肿;积极预防肺部感染、肺不张,腹腔、胰腺周围感染,以及后期二重真菌感染等。Objective To review the key points of non-surgical treatment of acute severe pancreatitis. Methods Clinical data of 61 patients with severe acute pancreatifis treated in Chang＇an Hospital from September 2009 to September 2014 were retrospectively analyzed. Results Among 61 patients 41 were males and 20 females with a mean age of 43.5 ＋4.6 years （ 18 -78y）. Three cases died during treatment, 2 cases underwent surgical drainage 2 weeks after onset due to the formation of pancreatic abscess, biliary tract drainage was performed in 3 cases with progressive jaundice caused stone obstruction. Peripancreatic pseudocyst occurred in 16 cases, including surgical drainage in 6 cases 3 -6 months after onset, and the remaining 37 patients were cured and discharged after 4 -6 weeks of conservative treatment. Conclusion The key points of early treatment include fast fluid resuscitation, correction of hypovolemic shock; early adoption of laxative enema, reduction of intra-abdominal pressure; alleviation of abdominal and pancreatic edema; active prevention of infection.

关 键 词：重症急性胰腺炎 早期非手术治疗 关键点 

分 类 号：R576[医药卫生—消化系统]