• 1.貴陽醫(yī)學(xué)院附屬醫(yī)院急救中心（貴陽550004）;;
  • 2.貴陽醫(yī)學(xué)院公共衛(wèi)生學(xué)院（貴陽550004）;

【摘要】目的 探討靜脈導(dǎo)管置管引流在治療重癥急性胰腺炎（SAP）中的作用。
方法 2002年8月至2004年5月我院共收治SAP患者113例，根據(jù)治療方式不同分為靜脈導(dǎo)管腹腔引流組（簡稱靜脈導(dǎo)管組，45例）和常規(guī)治療組(68例)，兩組常規(guī)治療一致。比較兩組患者的療效和APACHEⅡ評分，并監(jiān)測腹腔引流和腹內(nèi)壓情況。
結(jié)果 兩組患者在性別、年齡及入院時(shí)APACHEⅡ評分方面差異均無顯著性意義(P gt;0.05)。 治療后第2天和第5天，靜脈導(dǎo)管組的APACHEⅡ評分明顯低于常規(guī)治療組(P=0.000)。靜脈導(dǎo)管組的住院時(shí)間明顯縮短（P=0.000），囊腫發(fā)生率低于常規(guī)治療組(P=0.000)，死亡率(8.9%)與常規(guī)治療組(19.1%)間差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05)。靜脈導(dǎo)管組的腹內(nèi)壓與腹腔引流量、住院時(shí)間 及APACHEⅡ評分均呈正相關(guān)，相關(guān)系數(shù)分別為0.552、0.748和0.923，P=0.000。
結(jié)論 靜脈導(dǎo)管置管引流在治療重癥急性胰腺炎中有重要作用。

引用本文： 李昆,孫誠誼,孫早喜,王義平,張磊冰,黃海溶. 靜脈導(dǎo)管置管在治療重癥急性胰腺炎中的作用. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(4): 406-408. doi: 復(fù)制

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. 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. 汪訓(xùn)實(shí),高友兵,張兆林. 破壞胰腺被膜對重癥急性胰腺炎大鼠死亡的影響 [Ｊ]. 美國中華外科學(xué)雜志, 2000; 1(1)∶35.
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5. 張圣道,雷若慶. 重癥急性胰腺炎的診治方案及發(fā)展趨勢 [Ｊ]. 中華肝膽外科雜志, 2004; 10(4)∶219.
6. 封光華,蔡陽,賈鵬輝,等. 聯(lián)合血液濾過和腹膜透析治療急性重癥胰腺炎 [Ｊ]. 中華外科雜志, 2004; 42(5)∶272.
7. 周總光,袁朝新,孫煒,等. 重癥急性胰腺炎腹腔鏡手術(shù)治療的臨床研究 [Ｊ]. 中華外科雜志, 2001; 39(4)∶272.
8. Cuschieri A. Pancreatic necrosis: pathogenesis and endoscopic management [Ｊ]. Semin Laparosc Surg, 2002; 9(1)∶54.
9. Appelros S, Lindgren S, Borgstrom A. Short and long term outcome of severe acute pancreatitis [Ｊ]. Eur J Surg, 2001; 167(4)∶281.
10. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [Ｊ]. J Am Coll Surg, 1995; 180(6)∶745.
11. 孫家邦,朱斌. 暴發(fā)性胰腺炎的診斷及治療 [Ｊ]. 中國實(shí)用外科雜志, 2004; 24(1)∶23.
12. Gecelter G, Fahoum B, Gardezi S, et al. Abdominal compartment syndrome in severe acute pancreatitis: an indication for a decompressing laparotomy? [Ｊ]. Dig Surg, 2002; 19(5)∶402JP213Iberti TJ, Lieber CE, Benjamin E. Determination of intraabdominal pressure using a transurethral bladder catheter: clinical validation of the technique [Ｊ]. Anesthesiology, 1989; 70(1)∶47.
13. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement [Ｊ]. J Am Coll Surg, 1998; 186(5)∶594.
14. Lacey SR, Bruce J, Brooks SP, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects [Ｊ]. J Pediatr Surg, 1987; 22(12)∶1207.
15. JP2Malbrain MLNG. Intraabdominal pressure in the ICU: clinical tool or toy? In: Vincent JL ed. Yearbook of intensive care and emergency medicine [M]. Berlin: SpringerVerlag, 2001∶547-585.
  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. 汪訓(xùn)實(shí),高友兵,張兆林. 破壞胰腺被膜對重癥急性胰腺炎大鼠死亡的影響 [Ｊ]. 美國中華外科學(xué)雜志, 2000; 1(1)∶35.
  4. 4. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)胰腺學(xué)組. 急性胰腺炎的臨床診斷及分級標(biāo)準(zhǔn)(1996年第二次方案) [Ｊ]. 中華外科雜志, 1997; 35（12）∶773.
  5. 5. 張圣道,雷若慶. 重癥急性胰腺炎的診治方案及發(fā)展趨勢 [Ｊ]. 中華肝膽外科雜志, 2004; 10(4)∶219.
  6. 6. 封光華,蔡陽,賈鵬輝,等. 聯(lián)合血液濾過和腹膜透析治療急性重癥胰腺炎 [Ｊ]. 中華外科雜志, 2004; 42(5)∶272.
  7. 7. 周總光,袁朝新,孫煒,等. 重癥急性胰腺炎腹腔鏡手術(shù)治療的臨床研究 [Ｊ]. 中華外科雜志, 2001; 39(4)∶272.
  8. 8. Cuschieri A. Pancreatic necrosis: pathogenesis and endoscopic management [Ｊ]. Semin Laparosc Surg, 2002; 9(1)∶54.
  9. 9. Appelros S, Lindgren S, Borgstrom A. Short and long term outcome of severe acute pancreatitis [Ｊ]. Eur J Surg, 2001; 167(4)∶281.
  10. 10. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [Ｊ]. J Am Coll Surg, 1995; 180(6)∶745.
  11. 11. 孫家邦,朱斌. 暴發(fā)性胰腺炎的診斷及治療 [Ｊ]. 中國實(shí)用外科雜志, 2004; 24(1)∶23.
  12. 12. Gecelter G, Fahoum B, Gardezi S, et al. Abdominal compartment syndrome in severe acute pancreatitis: an indication for a decompressing laparotomy? [Ｊ]. Dig Surg, 2002; 19(5)∶402JP213Iberti TJ, Lieber CE, Benjamin E. Determination of intraabdominal pressure using a transurethral bladder catheter: clinical validation of the technique [Ｊ]. Anesthesiology, 1989; 70(1)∶47.
  13. 13. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement [Ｊ]. J Am Coll Surg, 1998; 186(5)∶594.
  14. 14. Lacey SR, Bruce J, Brooks SP, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects [Ｊ]. J Pediatr Surg, 1987; 22(12)∶1207.
  15. 15. JP2Malbrain MLNG. Intraabdominal pressure in the ICU: clinical tool or toy? In: Vincent JL ed. Yearbook of intensive care and emergency medicine [M]. Berlin: SpringerVerlag, 2001∶547-585.