急性胰腺炎的超声诊断分析

目的:探讨超声对急性胰腺炎诊断分析和意义。方法回顾性分析超声诊断急性胰腺炎均与CT、检验结果进行对照。结果急性胰腺炎声像特点表现为:胰腺大小肿大或正常;包膜光滑或毛糙;实质回声减低、增强或无明显异常;胰管扩张有或无;胰周可见液性暗区或包块回声;下腹腔积液有或无;上腹部气体全反射回声有或无。结论超声与CT对比仍可作为急性胰腺炎的首要检查,并在有些方面占其优势。

重症急性胰腺炎并发胰性脑病的护理

目的探讨提高重症胰腺炎合并胰性脑病的救护成功率的方法。方法根据患者具体情况,按照个体化的原则,严密观察病情,合理营养支持,加强基础护理,减少并发症发生。结果本组17例,死亡8例,治愈5例,好转4例。结论重症急性胰腺炎并发胰性脑病,预后差,需严密观察病情,精心护理,加强营养支持,预防并发症,提高生存质量。

C-反应蛋白和尿胰岛蛋白酶原-2在急性胰腺炎诊断中的意义

目的探讨尿胰岛蛋白酶原-2和C-反应蛋白在急性胰腺炎诊断中的意义。方法 96例急性胰腺炎患者入院后均给予C-反应蛋白和尿胰岛蛋白酶原-2检测,并进行动态监测。结果轻症组CRP峰值则出现在入院当天;重症组的CRP峰值则出现在第3天,入院给予治疗后,轻症组的C-反应蛋白和尿胰岛蛋白酶原-2均明显降低,重症组则略有下降。结论检测急性胰腺炎患者C-反应蛋白和尿胰岛蛋白酶原-2为临床诊断、治疗及预后提供了良好的临床依据。

CRP在急性胰胰炎患者中的临床意义

急性胰腺炎（AP）是一种胰腺及周围组织被胰腺分泌的消化酶自身消化的化学性炎，血尿淀粉酶（AMY—S、AMY—u）、血脂肪酶（LP）、淀粉酶肌酐清除率（CAMY-/Ccr）、尿胰蛋白酶原-2是实验室诊断AP的常规传统指标．各有优缺点．但升高程度与AP的严重程度均不呈相关性。根据有关报道．C-反应蛋白（CRP）可作为判断AP严重程度的重要指标．本文即通过对118例AP患者CRP和各常规AP诊断指标水平的观察．以探讨CRP在AP中的意义。

1例肾移植术后急性胰腺炎患者的护理

急性胰腺炎是胰腺及其周围组织被胰腺分泌的消化酶自身消化的化学性炎症，是常见的急腹症之一。该病发病急，变化快，并发症多，可发生休克和多器官功能衰竭，病死率高。2010—03笔者所在科收治了1例肾移植术后合并2型糖尿病突发急性胰腺炎患者，经精心治疗与护理，患者胰腺炎好转，未出现其它并发症，现将护理体会报告如下。

胰腺移植片固定膜的闭合率

目前,胰腺移植片固定膜应用广泛,但对此固定膜开放持缓性的研究并不多,而且衡量其开放性的指标也不够标准.下面是我们的研究.方法:我们观察在0.98kPa水柱压下是否有水流通过固定膜并检测其开放性.将固定膜之管一端塞入多乙烯苯小杯底部,杯中置10mm高水柱.若有水流通过固定膜,则说明其在0.98kPa水压下可开放.在16个月中,我们从57例患者中移出69块固定膜,其长度78％为2～2.5cm,22％为3～10cm,共分四型:5型(26例),6型(8例),7型(3~3例),和10型(2例).这些固定膜是从以下患者体中移出,而后复原。

大黄素对急性胰腺炎大鼠胰腺核因子-kB活化的影响

目的观察大黄素对急性胰腺炎(AP)大鼠胰腺组织核因子-kB(NF-kB)活化的影响,初步阐明大黄素治疗 AP 的分子作用机制。方法雄性 SD 大鼠采用持续输注雨蛙素(5 μg·kg^(-1)·h^(-1))法建立急性水肿性胰腺炎模型,分为注射后5、30min 及1、2、4、6 h 组,停止输注后6h 组;造模前2h 大鼠腹腔注射大黄素(10、30、100mg/kg)组及生理盐水对照组。采用电泳迁移率改变分析实验检测 NF-kB DNA 结合活性,Western blot 检测 NF-kB 抑制蛋白(ⅠkBs)的ⅠkBα和ⅠkBβ降解水平,Northern blot 检测 NF-kB 信号下游效应分子单核细胞趋化蛋白-1(MCP-1)和细胞间粘附分子-1(ICAM-1)基因表达。结果超生理剂量的雨蛙素可诱导大鼠胰腺 NF-kB 发生双相活化,活化高峰出现在雨蛙素注射30min 和4h 后,其相对面积灰度值分别为正常对照的(3.9±2.0)和(7.7±3.2)倍(n=4,P 值均<0.01)。大黄素10、30和100mg/kg剂量治疗组大鼠胰腺 NF-kB 活性较 AP 模型组分别下降45%,62%和84%(30min)和28%,74%和80%(4h,n=4,P 值均<0.01)。同时,大黄素(100mg/kg)可明显抑制雨蛙素诱导的胰腺ⅠkBα和ⅠkBβ蛋白降解(n=4,P 值均<0.01)。与其对 NF-kB 活化的抑制作用一致,大黄素剂量依赖性地抑制雨蛙素诱导的胰腺 MCP-1和 ICAM-1基因表达。结论大黄素可抑制胰腺内ⅠkBs/NF-kB 信号转导通路活化,从而抑制炎性细胞因子和粘附分子基因表达,发挥其对 AP 的治疗作用。

早期肠内营养对老年重症急性胰腺炎患者肠黏膜屏障功能及肾功能的影响

探讨早期肠内营养对老年SAP患者并发症的影响。结果显示,48h内行肠内营养的老年SAP患者血肌酐、尿素氮、胱抑素C、肾小球滤过率、降钙素原、肿瘤坏死因子-α、白介素1、血二胺氧化酶、D-乳酸等指标优于48~72h内行肠内营养患者,表明老年SAP患者48h内行肠内营养支持治疗可以保护肠黏膜屏障功能,减轻肾损伤,降低并发症发生率。

假性胰腺囊肿诊治分析

假性胰腺囊肿是急性水肿性胰肿炎和胰腺外伤常见并发症,近年我院共手术治疗假性胰腺囊肿30例,效果满意,现报告如下.

慢性胰腺炎合并急性梗阻性化脓性胰管炎致假性囊肿感染1例

急性梗阻性化脓性胰管炎在临床上十分罕见,本文报道1例慢性胰腺炎合并急性梗阻性化脓性胰管炎,并在此基础上继发假性囊肿感染的病例,分析了假性囊肿感染的原因,并探讨了内镜治疗及抗感染治疗的策略与挑战。

急性梗阻性化脓性胰管炎的临床特征及诊治措施

目的分析急性梗阻性化脓性胰管炎(AOSPD)的临床特征、治疗方案及预后,探讨其发病机制、诊治策略。方法收集1993年6月至2019年1月间中外文献报道的63例AOSPD患者,记录患者的性别、发病年龄、病因及可能的危险因素、临床表现、实验室检查结果、影像学表现、治疗方案和预后。结果AOSPD患者男女比例为53∶10,发病中位年龄59岁。病因及危险因素包括慢性胰腺炎、胰腺肿瘤、糖尿病及发病前有内镜干预和饮酒史等。临床表现主要为上腹痛和发热,少数可出现脓毒血症和休克。发病早期血淀粉酶水平为13~1 946 IU/L,治疗后有不同程度降低。影像学检查发现胰管扩张54例、胰管结石42例。胰液培养31例阳性,常见病原菌为肠球菌、大肠杆菌。主要治疗措施包括内镜下胰管支架置入术(36例)、内镜下鼻胰管引流术(22例)、外科手术(4例)和抗生素治疗等,治疗后病情均有不同程度的改善。结论高龄、男性、慢性胰腺疾病、内镜操作史、饮酒史、糖尿病等是AOSPD的主要发病因素。AOSPD临床表现无特异性,但可出现严重并发症。影像学检查和胰液培养有助于确诊。抗生素治疗和及时内镜介入、外科手术等处理可改善患者短期预后。

ERCP诊治小儿急性梗阻性化脓性胰管炎合并胰腺分裂症一例

患儿,男,14岁,以反复上腹部胀痛为主要表现就诊,曾诊断为慢性胰腺炎并行经内镜逆行胰胆管造影术(ERCP)治疗,病情无明显好转,疼痛持续,血淀粉酶略有升高但不超过3倍正常上限,炎症指标略有升高,结合磁共振胰胆管成像术(MRCP)评估考虑急性梗阻性化脓性胰管炎(AOSPD)合并胰腺分裂症可能,经ERCP明确诊断并治疗后,患儿疼痛消失,血淀粉酶及炎症指标恢复正常。

ユニチカ公司用酶法开发镁离子测定器

公司与公司首次利用酶共同开发了测定镁离子的药盒。这是利用酶需要金属离子作为辅酶的性质而开发的药盒,是新的酶诊断法的发展。详细的技术在7月9日东京召开的微量金属代谢研究会上发表。等待厚生省的认可,估计最近可以销售。血清镁离子在肾衰竭、白血病、阿狄森氏病、甲状腺机能减退症等情况下增高,在呼吸不全、下痢、呕吐、醇性肝硬变、急性胰炎、甲状腺机能亢进症等情况下降低。已成为多数诊断的线索。

Severe acute pancreatitis: Clinical course and management

Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

Severe acute pancreatitis: Pathogenetic aspects and prognostic factors

Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.

Blockade of high mobility group box-1 protein attenuates experimental severe acute pancreatitis

AIM： To examine the effects of anti-high mobility group box 1 （HIGB1） neutralizing antibody in experimental severe acute pancreatitis （SAP）. METHODS： SAP was induced by creating closed duodenal loop inC3H/HeN mice. SAP was induced immediately after intrapedtoneal injection of anti-HMGB1 neutralizing antibody （200 pg）. Sevedty of pancreatitis, organ injury （liver, kidney and lung）, and bacterial translocation to pancreas was examined 12 h after induction of SAP. RESULTS： Anti-HHGB1 neutralizing antibody significantly improved the elevation of the serum amylase level and the histological alterations of pancreas and lung in SAR Anti-HHGB1 antibody also significantly ameliorated the elevations of serum alanine aminotransferase and creatinine in SAR However, anti-HHGB1 antibody worsened the bacterial translocation to pancreas. CONCLUSION： Blockade of HHGB1 attenuated the development of SAP and associated organ dysfunction, suggesting that HHGB1 may act as a key mediator for inflammatory response and organ injury in SAR

Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis

AIM： To investigate whether continuous veno-venous hemofiltration （CVVH） in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis. METHODS： Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain （late CVVH, n= 10）. Group 3 underwent high-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 4 received high-volume CVVH after 96 h of theonset of abdominal pain （late CVVH, n = 9）. CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CVVH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific ELISA. The Solartron 1 255 B frequency response analyzer （British） was used to observe the resistance of filter membrane. RESULTS： The survival rate had a significant difference （94.44% vs68.42%, P〈0.01） high-volume and low-volume CVVH patients. The survival rate had also a significant difference （88.89% vs 73.68%, P〈0.05） between early and late CVVH patients. The hemodynamic deterioration （MAP, HR, CVP） was less severe in groups 4 and 1 bhan that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed, serum TNF-α concentrations had a negative correlationwith resistance （r： -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2; -0.88, -0.92, and -0.82, respectively in group 3; -0.84, -0.87, and -0.79, respectively in group 4）. The decreasing extent of TNF-α, IL-1β and IL-6 was significantly different between group 3 and group I （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 4 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 1 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.05）, and between group 3 and group 4 （TNF-α P〈0.01, IL-1β P〈0.01, IL-6 P〈0.05）, respectively during CVVH period. The decreasing extent of TNF-α and IL-1β was also significantly different between survival patients and dead patients （TNF-α P〈0.05, IL-1β P〈0.05）. In survival patients, serum concentration of TNF-α and IL-1β decreased more significantly than that in dead patients. CONCLUSION： High-volume and early CWH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more effidently than low-volume CVVH. The survival rate is related to the decrease extent of TNF-α and IL-1β. The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated.

Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS:Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION:Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis.Large bore drainages did not prove to be more effective in controlling the septic focus.