重视重度急性胰腺炎肠功能障碍的防治

Pay Emphasis to Prevention and Treatment of Intestinal Dysfunction in Severe Acute Pancreatitis

重度急性胰腺炎(SAP)是临床常见的急危重症,尤其是在继发胰腺坏死组织感染时,其病死率可高达40%。肠黏膜屏障功能障碍和肠源性细菌易位是引起胰腺坏死组织和胰周积液感染、促使全身性炎症反应综合征(SIRS)和多器官功能障碍综合征(MODS)发生的主要原因。由于肠道功能多样,难以归纳总结,且目前缺乏特异的、客观的评价指标,故肠功能障碍并未被纳入"2012版急性胰腺炎分类——亚特兰大国际共识分类和定义修订"的改良Marshall器官衰竭评估体系中。临床工作中重视SAP肠功能障碍的防治,是减少胰腺坏死组织感染,防止MODS发生、发展,降低SAP病死率的关键。本文对SAP肠功能障碍的发生机制及其防治作一阐述。

Severe acute pancreatitis（ SAP）,especially with secondary infection of pancreatic necrotic tissue,is clinically a very severe and critical condition. The mortality rate can be as high as 40%. Intestinal barrier dysfunction and translocation of enteric bacteria contribute to the infection of pancreatic necrotic tissue and peripancreatic accumulated fluid,promote systemic inflammatory response syndrome（ SIRS） and multiple organ dysfunction syndrome（ MODS）.Because there is no specific and objective assessment criteria for intestinal function and the function is diversity,intestinal dysfunction is not included in the modified Marshall organ dysfunction scoring system in 2012 revision of the Atlanta International Consensus on Classification and Definitions of Acute Pancreatitis. Paying emphasis to prevention and treatment of intestinal dysfunction may reduce the infection of pancreatic necrotic tissue,preventing the progress of MODS and reducing the mortality rate of SAP. This article reviewed the pathogenic mechanism as well as prevention and treatment of intestinal dysfunction in SAP.