基于指南强化重症急性胰腺炎的综合评估和治疗  

Comprehensive evaluation and treatment of severe acute pancreatitis based on guidelines

作　　者：许利明[1] 郑悦亮(审校)[1] XU Liming;ZHENG Yueliang(Department of Emergency,Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou,310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)急诊医学科,杭州310014

出　　处：《临床急诊杂志》2022年第12期837-841,共5页Journal of Clinical Emergency

基　　金：浙江省中医药重点研究项目(No:2020ZZ002,2021ZZ003);浙江省卫生健康科技计划临床研究应用项目(No:2022KY582);浙江省中医药科学研究基金项目(No:2021ZA016,2022ZB030)。

摘　　要：重症急性胰腺炎(SAP)是急诊常见的急危重症之一,国内外多个协会颁布了SAP相关诊疗指南,促进了SAP治疗的同质化,提高了SAP治疗的效果。然而,在临床过程中,SAP的治疗依然面临着早期对于病情严重程度的误判,导致部分中度重症急性胰腺炎进展为SAP、液体复苏不足或过度造成持续性的脏器功能损伤、后期感染失控导致病程迁延甚至死亡等问题。本文就近年来发表的SAP相关指南,结合临床实践,从SAP早期预警、早期液体复苏、病因治疗、脏器功能保护、营养支持治疗、感染性胰周坏死的处置等6个方面进行探讨,旨在为临床医生诊治SAP提供实用性建议。Severe acute pancreatitis(SAP) is one of the most common critical illnesses in the emergency department. Many associations have issued SAP-related guidelines, promoting the homogeneity of SAP treatment and improving the effect of SAP treatment. However, in the clinical process, the treatment of SAP is still faced with early miscalculation of the severity of the disease, leading to the progression of some moderate severe acute pancreatitis to SAP. Persistent organ function damage results from insufficient or excessive fluid resuscitation. Infectious pancreatic necrosis leads to the delay of the course of disease and even death. This article combined the SAP-related guidelines published in recent years with the author’s clinical practice, discusses six aspects of SAP early warning, early fluid resuscitation, etiological treatment, organ function protection, nutritional support treatment, and disposal of infectious peripancreatic necrosis.

关 键 词：重症急性胰腺炎 液体复苏 多脏器功能障碍 

分 类 号：R576[医药卫生—消化系统]