重症急性胰腺炎合并急性肾损伤的临床预防  

Clinical prophylaxis of severe acute pancreatitis combined with acute kidney injury

作　　者：陈闻婕 钟鸣[1] 陈影[1] 陈尔真[1] Chen Wenjie;Zhong Ming;Chen Ying;Chen Erzhen(Department of Emergency,Affiliated Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院急诊科,上海200025

出　　处：《中国中西医结合急救杂志》2022年第5期513-517,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：上海申康医学发展中心项目(SHDC22021304);上海市医学领军人才项目(2017-0061)。

摘　　要：重症急性胰腺炎(SAP)是急诊科和重症医学科常见的消化系统急危重症。其中,急性肾损伤(AKI)是SAP常见的器官功能障碍。当SAP合并AKI,特别是需要肾脏替代治疗时,往往提示不良的临床预后。因此,早期预测SAP合并AKI的发生,并采取相应的临床措施进行预防,对改善SAP患者临床预后尤其重要。本文就SAP合并AKI的早期预警及临床预防进行综述。在早期预警方面,SAP合并AKI的危险因素包括高龄、高脂血症型急性胰腺炎、存在慢性基础疾病、SAP并发脓毒症、腹腔高压、腹腔出血或胸腔积液等;新型生物标志物如胱抑素-C、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)等有助于早期预测SAP合并AKI的发生;影像学方法包括电子计算机断层扫描(CT)评分和超声检查对预测SAP合并AKI的发生具有一定的临床价值;AKI人工智能预警系统是未来预测及诊断SAP合并AKI的主要发展方向。在临床预防方面,避免肾脏损害性治疗和检查是预防SAP合并AKI的首要措施;早期合理的液体管理、减少含氯液体的应用可预防AKI的发生;血液净化治疗通过清除炎症介质、协助液体管理以及降低血脂水平等实现对SAP合并AKI的预防。Severe acute pancreatitis(SAP)is a common critical illness of digestive system in the department of emergency and intensive care unit(ICU).Acute kidney injury(AKI)is a common organ dysfunction of severe acute pancreatitis.When SAP is combined with AKI especially when renal replacement therapy is in need,it often suggests a poor clinical prognosis.Therefore,early prediction of the occurrence of SAP combined with AKI and taking corresponding relevant clinical measures for prophylaxis are especially important to improve the clinical prognosis of patients with SAP.This article reviews the early warning and clinical prophylaxis of SAP with AKI.In terms of early warning,the risk factors of SAP combined with AKI include advanced age,hyperlipidemia type of acute pancreatitis,presence of chronic fundamental diseases,SAP complicated with sepsis,abdominal hypertension,abdominal hemorrhage or pleural effusion,etc;novel biomarkers such as cystatin-C,neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1)and so on can help early predict the occurrence of SAP combined with AKI;imaging methods such as computed tomography(CT)score and ultrasound examination have certain clinical values in predicting the occurrence of SAP with AKI;AKI artificial intelligence early warning system is the main future development direction of the prediction and diagnosis of SAP combined with AKI.In terms of clinical prevention,avoiding nephrotoxic treatment and examination is the primary measure to prevent SAP combined with AKI;early and reasonable fluid management and reducing the application of chlorine-containing liquid can be used to prevent the occurrence of AKI;blood purification treatment prevents SAP combined with AKI by removing inflammatory mediators,assisting in fluid management,lowering the level of blood lipid,etc.

关 键 词：重症急性胰腺炎 急性肾损伤 危险因素 生物标志物 液体管理 血液净化 

分 类 号：R576[医药卫生—消化系统] R692[医药卫生—内科学]