• 貴陽醫(yī)學(xué)院附屬醫(yī)院急診外科重癥監(jiān)護(hù)病房(貴陽550001);

目的  探討5例特重型胰腺炎的特點(diǎn)及治療方法。
方法  我院2001年8月至2003年8月共收治特重型胰腺炎患者5例。其中入院后18 h內(nèi)心跳、呼吸驟停3次的重癥急性胰腺炎(SAP)1例,治療以及時(shí)血液濾過和心、肺、腦復(fù)蘇為重點(diǎn); SAP并發(fā)胰性腦病2例,以大劑量維生素B1的補(bǔ)充,或足量補(bǔ)給濃縮紅細(xì)胞為治療重點(diǎn); 并發(fā)多個(gè)器官功能障礙的暴發(fā)性胰腺炎(FAP)2例,治療重點(diǎn)是血液濾過和防治多器官功能衰竭的級(jí)聯(lián)放大反應(yīng),其中1例以高滲性糖昏迷為主要表現(xiàn),治療重點(diǎn)是內(nèi)穩(wěn)態(tài)的糾正,血液濾過,重要器官功能維護(hù)。
結(jié)果  5例特重型胰腺炎患者均治愈,平均住院時(shí)間為32.2 d。
結(jié)論  器官功能的復(fù)蘇和維護(hù)、外科ICU監(jiān)護(hù)、短時(shí)血液濾過、內(nèi)穩(wěn)態(tài)的糾正、中西藥綜合治療及病因、對(duì)癥的個(gè)體化治療是特重型胰腺炎的重要治療措施。

引用本文: 李昆,孫早喜,張靜萍,白冰,孫誠(chéng)誼,夏亮芳. 5例特重型胰腺炎治療分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004, 11(6): 534-535. doi: 復(fù)制

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2. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations [J]. J Am Coll Surg, 1998; 187(3)∶255.
3. 陶京,王春友,楊智勇,等. 不同血濾方法治療重癥急性胰腺炎療效比較及適應(yīng)證探討 [J]. 中華實(shí)驗(yàn)外科雜志, 2003; 20(10)∶737.
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5. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup [J]. Pancreas, 2001; 22(3)∶274.
6. Wang X, Wang B, Wu K, et al.Growth hormone downregulate the excess apoptosis of intestinal epithelial cells in rats during the early course of acute necrotizing pancreatitis [J]. Pancreas, 2002; 25(2)∶156.
7. 王興鵬. 重視腸道衰竭在重癥急性胰腺炎發(fā)病中的作用 [J]. 中華消化雜志, 2002; 22(1)∶5.
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  1. 1. Bank S, Singh P, Pooran N, et al. Evaluation of factors that have reduced mortality from acute pancreatitis over the past 20 years [J]. J Clin Gastroenterol, 2002; 35(1)∶50.
  2. 2. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations [J]. J Am Coll Surg, 1998; 187(3)∶255.
  3. 3. 陶京,王春友,楊智勇,等. 不同血濾方法治療重癥急性胰腺炎療效比較及適應(yīng)證探討 [J]. 中華實(shí)驗(yàn)外科雜志, 2003; 20(10)∶737.
  4. 4. Norman J. The role of cytokines in the pathogenesis of acute pancreatitis [J]. Am J Surg, 1998; 175(1)∶76.
  5. 5. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup [J]. Pancreas, 2001; 22(3)∶274.
  6. 6. Wang X, Wang B, Wu K, et al.Growth hormone downregulate the excess apoptosis of intestinal epithelial cells in rats during the early course of acute necrotizing pancreatitis [J]. Pancreas, 2002; 25(2)∶156.
  7. 7. 王興鵬. 重視腸道衰竭在重癥急性胰腺炎發(fā)病中的作用 [J]. 中華消化雜志, 2002; 22(1)∶5.
  8. 8. 孫早喜,張靜萍,孫誠(chéng)誼. 特異、特重型胰腺炎救治探討(附二例報(bào)告) [J]. 中華醫(yī)藥學(xué)雜志, 2003; 2(7)∶65.
  9. 9. 何振平. 急性胰腺炎的并發(fā)癥臨床認(rèn)識(shí)與評(píng)價(jià) [J]. 消化外科, 2003; 2(4)∶297.
  10. 10. Matz R.Management of the hyperosmolar hyperglycemic syndrome [J]. Am Fam Physician, 1999; 60(3)∶1468.