急性胰腺炎的急诊救治新进展  

New progress in emergency treatment of acute pancreatitis

作　　者：陈三洋[1] 朱长举[1] Chen Sanyang;Zhu Changju(Emergency Medicine Department of the First Affiliated Hospital of Zhengzhou University,Henan Emergency and Trauma Engineering Research Center,Henan Emergency and Trauma Research Medical Key Laboratory,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院急诊医学部、河南省急诊与创伤工程研究中心、河南省急诊与创伤研究医学重点实验室,河南郑州450052

出　　处：《中国急救医学》2024年第10期903-907,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金面上项目(82372197);河南省医学科技攻关联合共建项目(LHGJ20220338)。

摘　　要：急性胰腺炎(acute pancreatitis,AP)是引起急性腹痛的常见病因之一,其病情可分为轻症急性胰腺炎(MAP)、中重度急性胰腺炎(MSAP)及重症急性胰腺炎(SAP),其中SAP的发病率约为25%。SAP病情危重,常合并多脏器功能障碍,病死率高达30%。AP的病因在我国以胆源性、高脂性和酒精性居多,其发病机制主要包括胰蛋白酶原的异常激活、病理性钙离子(Ca 2+)信号、线粒体功能紊乱等。AP的治疗目前以补液、抗炎等内科综合治疗和内镜、穿刺等微创治疗为主。与传统手术治疗相比,近年来出现的如升阶梯治疗策略等新的治疗方法具有显著优势。因此,充分了解AP患者的相关危险因素及发病机制,应用不同方法对患者严重程度进行评估,以采取有效方式进行治疗,能明显改善患者预后。Acute pancreatitis(AP)is one of the most common causes of acute abdominal pain,and is divided into mild acute pancreatitis(MAP),moderate to severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP).The incidence of SAP is about 25%,and the condition is more severe at this time,often accompanied by multiple organ dysfunction,with a mortality rate as high as 30%.The etiology of AP in China is mainly biliary,high-fat and alcoholic,and its pathogenesis mainly includes abnormal activation of trypsinogen,pathological Ca ion(Ca 2+)signaling,mitochondrial dysfunction,etc.The current treatment for AP mainly includes comprehensive internal medicine treatments such as fluid replacement and anti-inflammation,as well as minimally invasive treatments such as endoscopy and puncture.Compared with traditional surgical treatment,new treatment methods such as ascending ladder therapy have significant advantages in recent years.In summary,fully understanding the relevant risk factors and pathogenesis of AP patients,applying different methods to evaluate the severity of patients,and adopting appropriate treatment methods can significantly improve patient prognosis.

关 键 词：急性胰腺炎 病因 发病机制 治疗 外泌体 升阶梯治疗 

分 类 号：R576[医药卫生—消化系统]