经内镜鼻胰管引流在重症急性胰腺炎治疗中的应用

Use of endoscopic naso-pancreatic drainage in the treatment of severe acute pancreatitis

目的 :初步总结经内镜鼻胰管引流在重症急性胰腺炎治疗中应用的疗效。 方法 :自 1998年 3月以来 ,在重症急性胰腺炎患者入院后常规非手术监测治疗的同时 ,随机床旁行经内镜置放鼻胰管引流 14例。其中明确合并胆结石 8例。观察每天胰管引流量和入院后第 5天在体温、心率、白细胞计数、血糖、血钙、动脉氧分压和血、尿淀粉酶的变化 ,并与第 1天比较 ,记录治疗结果和住院时间。 结果 :经鼻胰管引流时间为 (7.3± 4 .0 )天 ,前 5天的胰液引流量分别为每天 (2 36 .4± 176 .6 )、(2 87.1± 16 4 .7)、(2 84 .6± 2 16 .4 )、(435 .0± 35 7.8)ml和 (377.8± 2 2 3.8)ml。入院后第 1天和第 5天的体温为 (38.2± 0 .6 )和 (37.2± 0 .8)℃ (P <0 .0 1)、心率为 (10 2 .3± 17.0 )和 (82 .9± 14 .5 )次 /min(P <0 .0 1) ,白细胞计数为 (14 .6± 4 .2 )和 (10 .1± 5 .4 )× 10 9/L(P <0 .0 5 ) ,血糖为 (10 .0± 4 .9)和 (8.6± 3.3)mmol/L(P >0 .0 5 ) ,血钙为 (2 .1± 0 .2 )和 (2 .2± 0 .2 )mmol/L(P >0 .0 5 ) 动脉氧分压为 (78.0± 16 .3)和 (113.0± 4 1.6 )mmHg(P <0 .0 1) ,血淀粉酶为 (6 95 .7± 4 4 5 .2 )和 (82 .6± 4 7.1)U/L(P <0 .0 1) ,尿淀粉酶为 (3174 .1± 2 5 4 2 .5 )和(2 86 .8±

Objectives:To review the primary experience about the use of endoscopic naso pancreatic drainage (ENPD) in the treatment of severe acute pancreatitis (SAP). Methods:Under the regular management of SAP with non operative method as main means, ENPD was used in 14 patients, with the age of (41.3±15.9)years, the male and female sex category of 8 and 6, and the time of (32.9±22.8)hours from the onset to admission. Among which 8 cases were diagnosed coupling with gallbladder stones. The daily output of pancreatic fluid was measured. The body temperature, heart rate, blood glucose, blood calcium, PaO 2 ,and blood and urine levels of amylase were dynamically detected. The treatment result and the hospital stay time were recorded. Results:The duration of drainage was (7.3± 4.0) days. The daily drainage output of the first five days were (236.4±176.6),(287.1±164.7),(284.6±216.4),(435.0±357.8)ml and (377.8±223.8)ml , respectively. The decreases in body temperature, heart rate ,WBC counts, blood and urine levels of amylase and the increase in PaO 2 were significant on the fifth day when compared with those on the first day. The infection of pancreatic necrosis was found in one patient and controlled after changing the anti septic drugs. All patients were cured and the hospital stay time was (28.1±11.6) days. Conclusions:ENPD is an effective method for the drainage of pancreatic fluid and may play an important role in the treatment of SAP.