重症急性胰腺炎的早期处理

The Early Management of Severe Acute Pancreatitis

近20年来急性胰腺炎(acute pancreatitis,AP)诊治水平有了很大提高,病死率有所下降。随着循证医学的发展,AP治疗指南的纷纷出现,AP的治疗更加趋于科学化。目前一致认为早期处理是减轻胰腺坏死和缓解器官功能不全的重要步骤和关键时间,对改善其预后有着至关重要的作用。AP的处理首先需要明确AP的病因和预测严重程度,以致早期进行针对病因的治疗和决定是否需要加强治疗。AP的分型依据亚特兰大会议标准。Ranson评分、APACHEⅡ评分、CT、CRP等是AP严重程度评价的主要方法。早期处理主要包括:适量液体复苏、充分氧供、防治感染、镇静、镇痛、营养支持、抑制胰腺外分泌、促进胃肠功能的恢复、早期血滤、小剂量糖皮质激素应用。少数患者可能需要针对病因和局部并发症的手术治疗。

Because of improvements in the management including better diagnostics and treatment modalities, the mortality of acute pancreatitis （AP） has declined during the past 2 decades. With the development of evidence - based medicine, more and more guidelines in AP are published and the management is trended to convincing scientific evaluations. Appropriate early managements are the important step and critical time to alleviate pancreatic necrosis, relief organ dysfunction and improve prognosis. It is necessary to identify the causes and severity of AP before treatment, so as to take etiotropic therapy and intensive care or not. AP is divided as mild and severe type according to the Atlanta Symposium criteria. The severity of AP is mainly determined by Ranson score, APACHE Ⅱ , CT, CRP, et al. The early management of AP is including adequate fluid resuscitation, sufficient oxygen, preventing infection, sedation, analgesia, nutritional support, inhibiting pancreatic exocrinosity, promoting enterocinesia, blood filtration and small dose glucocorticoid infusion. A few patients maybe need surgery for the causes and local complications.