急性重症胰腺炎的临床护理研究进展

Research progress in clinical nursing of acute severe pancreatitis

急性重症胰腺炎属于急性胰腺炎的特殊类型,是一种病情险恶、并发症多、病死率较高的急腹症,占整个急性胰腺炎的10%~20%。急性重症胰腺炎患者的发病机制较为复杂,例如,胰酶自身消化、炎症介质和细胞因子、微循环障碍等都是目前比较重要的病机学说理论。胰腺本身的坏死组织分解溶化后可产生血管活性物质,如血管舒缓素、激肽及前列腺素等,使周围血管张力降低,加上胰周大量液体渗出、血容量锐减、血压下降均可进一步造成循环功能紊乱及肾脏损害。此外,坏死毒素中尚有心肌抑制因子和休克肺因子,可以引起心肺功能的损害。各器官功能障碍还可涉及肝脏和中枢神经系统等。所有这些病变统称为“酶性休克”。近些年来,急性重症胰腺炎药物、手术治疗水平不断提高,重症胰腺炎患者的生存率明显提高。但是会引发全身及局部并发症,不但加剧患者身体的痛苦,还要承担高额的治疗费用。因此,在完善治疗的同时,还要根据患者情况实施相应的护理措施。本文主要就急性重症胰腺炎的临床护理研究进行了分析与综述,希望为急性重症胰腺炎的治疗与护理提供借鉴。

Acute severe pancreatitis is a special type of acute pancreatitis. It is an acute abdomen with dangerous condition,many complications and high mortality,accounting for 10% to 20% of the whole acute pancreatitis. The pathogenesis of patients with acute severe pancreatitis is complex. For example,auto-digestion of pancreatic enzymes,inflammatory mediators and cytokines, and microcirculation disorders are all important pathogenesis theories at present. The necrotic tissue of the pancreas itself can be decomposed and dissolved to produce vasoactive substances,such as kallikrein,kinin and prostaglandin,etc.,which can reduce the tension of peripheral blood vessels,and the large amount of fluid exudation around the pancreas,the sharp decrease in blood volume and drop in blood pressure all can cause circulatory dysfunction and kidney damage. In addition,there are myocardial inhibitory factors and shock pulmonary factors in necrotic toxins,which can cause damage to heart and lung function. The dysfunction of various organs can also involve the liver and the central nervous system. All of these lesions are collectively referred to as "enzymatic shock". In recent years,the level of drugs and surgical treatment for acute severe pancreatitis has been continuously improved,and the survival rate of patients with severe pancreatitis has been significantly improved. However,it will lead to systemic and local complications,which not only aggravates the pain of the patient,but also bears high treatment costs. Therefore,while improving the treatment,it is also necessary to implement corresponding nursing measures according to the patient’s situation. This article mainly analyzes and reviews the clinical nursing research of acute severe pancreatitis,hoping to provide reference for the treatment and nursing of acute severe pancreatitis.