BACKGROUND: Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was re...BACKGROUND: Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was regarded as a poor prognosis sign of SAP, but the pathogenesis of PE in SAP still has not been clarified in the past decade. The purpose of this review is to elucidate the possible pathogenesis of PE in SAP. DATA SOURCES: The English-language literature concerning PE in this review came from the Database of MEDLINE (period of 1991-2005), and the keywords of severe acute pancreatitis and pancreatic encephalopathy were used in the searching. RESULTS: Many factors were involved in the pathogenesis of PE in SAP. Pancreatin activation, excessive release of cytokines and oxygen free radicals, microcirculation abnormalities of hemodynamic disturbance, ET-1/NO ratio, hypoxemia, bacterial infection, water and electrolyte imbalance, and vitamin B1 deficiency participated in the development of PE in SAP. CONCLUSIONS: The pathogenesis of PE in SAP has not yet been fully understood. The development of PE in SAP may be a multi-factor process. To find out the possible inducing factor is essential to the clinical management of PE in SAP.展开更多
What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,oc...What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,occurred with an accelerated episode of cough,productive sputum and a dropping down to 86%in SatO₂due to a cold weather.A diagnosis of pulmonary encephalopathy(PE)was made on the basis of the subsequent agitation and delirium,and the sedatives,such as quatiepine and haloperidol,had to be given for her mental excitation respectively,but she still pulled out indwelling needle herself and refused to any infusion therapy.As an alternative,a vaporized therapy integrated with tea herb drinking had to be applied to relieving her agitation,being designed as the vaporization of the inhaled oxygenation by means of high-flow oxygenation device(HFOD),with an ampoule of ambroxol mixed into the inhaler and simultaneous drinking of TCM tea herb for reducing sputum,helping dissolve the mucoid bolts inside her terminal bronchioles when being infected.We thought that a better efficacy would be achieved for hypercapnic encephalopathy due to AECOPD if we concentrate on a good ventilation of small airway through the vaporized therapy.展开更多
基金This work was supported by grants from the Technology Foundation of Traditional Chinese Medicine Science of Zhejiang Province (No.2003C130 No.2004C142)+4 种基金the Foundation of Medical Sciences and Technology of Zhejiang Province (No.2003B134)the Grave Foundation for Technological Development of Hangzhou (2003123B19)the Intensive Foundation for Technology of Hangzhou (No.2004Z006)the Foundation for Medical Sciences and Technology of Hangzhou (No.2003A004)the Foundation for Technology of Hangzhou (No.2005224).
文摘BACKGROUND: Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was regarded as a poor prognosis sign of SAP, but the pathogenesis of PE in SAP still has not been clarified in the past decade. The purpose of this review is to elucidate the possible pathogenesis of PE in SAP. DATA SOURCES: The English-language literature concerning PE in this review came from the Database of MEDLINE (period of 1991-2005), and the keywords of severe acute pancreatitis and pancreatic encephalopathy were used in the searching. RESULTS: Many factors were involved in the pathogenesis of PE in SAP. Pancreatin activation, excessive release of cytokines and oxygen free radicals, microcirculation abnormalities of hemodynamic disturbance, ET-1/NO ratio, hypoxemia, bacterial infection, water and electrolyte imbalance, and vitamin B1 deficiency participated in the development of PE in SAP. CONCLUSIONS: The pathogenesis of PE in SAP has not yet been fully understood. The development of PE in SAP may be a multi-factor process. To find out the possible inducing factor is essential to the clinical management of PE in SAP.
文摘What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,occurred with an accelerated episode of cough,productive sputum and a dropping down to 86%in SatO₂due to a cold weather.A diagnosis of pulmonary encephalopathy(PE)was made on the basis of the subsequent agitation and delirium,and the sedatives,such as quatiepine and haloperidol,had to be given for her mental excitation respectively,but she still pulled out indwelling needle herself and refused to any infusion therapy.As an alternative,a vaporized therapy integrated with tea herb drinking had to be applied to relieving her agitation,being designed as the vaporization of the inhaled oxygenation by means of high-flow oxygenation device(HFOD),with an ampoule of ambroxol mixed into the inhaler and simultaneous drinking of TCM tea herb for reducing sputum,helping dissolve the mucoid bolts inside her terminal bronchioles when being infected.We thought that a better efficacy would be achieved for hypercapnic encephalopathy due to AECOPD if we concentrate on a good ventilation of small airway through the vaporized therapy.
