63例急性重型胰腺炎临床分析

Clinical analysis of 63 patients with acute severe pancreatitis

目的：了解严密监测下治疗急性重型胰腺炎伴多器官功能损害患者的有效方法。方法：总结１９９２年５月～１９９６年４月收治的急性重型胰腺炎６３例，ＲＡＮＳＯＮ指标平均（６．４±１．７）项，ＡＰＡＣＨＥⅡ评分平均（２５．６±９．６）分。治疗采用中药“柴芩承气汤”加减以清热解毒，通里攻下，活血化瘀；适时进行手术清除胰腺及胰周坏死组织，充分引流；结合严密的生命体征和器官功能监测，早期预防和处理并发症，予机械通气，全胃肠外营养支持等综合措施。结果：４２例中药治疗，９例治愈，２９例中转手术，３例死亡，１例自动出院。４７例手术治疗，治愈或好转３９例，死亡８例。总病死率１７．５％。结论：通过严密监测并采取中西医非手术和手术疗法相结合的综合治疗措施，早期纠正全身病理生理紊乱和积极支持治疗，及时手术，能提高重型胰腺炎的治愈率，降低病死率。

Objective:To explore the effective way of treating acute severe pancreatitis (ASP) companied by multiple organ failure (MOF) under monitoring closely.Methods:Sixtythree cases of ASP hospitalized on May 1992 to April 1996 were treated with clearancing heat and detoxication using supplemented Chaiqin Chengqi Decoction,Tongli Gongxia ,activating blood flow and removing blood stasis,removing pancreatic and peripancreatic necrotic tissue via operation,draining fully;moreover,to monitor closely the vital signs and organ function as well as to preventing and treating complication early,mechanical ventilation,total parenteral nutrition (TPN) etc.In addition,the RANSON indexes of these patients were (6 4±1 7) item and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was (25 6±9 6)score.Results:Among 42 cases treated by TCM,9 cases were cured,29 cases were shifted to operation,3 cases died and 1 case was discharged voluntarily;among 47 cases treated with operation,39 cases were cured or improved,8 cases died.The total mortality was 17 5%.Conclusions:To monitoring closely,operation or nonoperation with TCM WM therapy,correcting the systemic pathophysiologic disturbances and active support treatment can enhance the curative rate and reduce the mortality of ASP.