Interpretation of 《Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis》_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIN Tao ¹ , LI Lan ¹ , ZHANG Xiaoying ¹ , HUANG Wei ² ,  XIA Qing ¹

1. West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University; Sichuan Provincial Pancreatitis Centre, Chengdu 610041, P. R. China;
2. West China Biobanks, Department of Research Management, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

XIA Qing, Email: xiaqing@medmail.com.cn

Keywords：

acute pancreatitis; Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis; traditional Chinese medicine; interpretation

DOI：

10.7507/1007-9424.202310043

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Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.

Citation： JIN Tao, LI Lan, ZHANG Xiaoying, HUANG Wei, XIA Qing. Interpretation of 《Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis》. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 205-211. doi: 10.7507/1007-9424.202310043 Copy

1.	中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南 (2021). 中国实用外科杂志, 2021, 41(7): 739-746.
2.	金涛, 黄伟, 张潇颖, 等. 急性胰腺炎中西医结合诊疗指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
3.	Zhou S, Buitrago C, Foong A, et al. Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis. Pancreatology, 2021, 21(8): 1405-1410.
4.	Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev, 2013(2): CD000567.
5.	de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N Engl J Med, 2022, 387(11): 989-1000.
6.	Jin T, Li L, Zhu P, et al. Optimising fluid requirements after initial resuscitation: a pilot study evaluating mini-fluid challenge and passive leg raising test in patients with predicted severe acute pancreatitis. Pancreatology, 2022, 22(7): 894-901.
7.	Froghi F, Soggiu F, Ricciardi F, et al. Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial. Int J Surg, 2022, 104: 106737. doi: 10.1016/j.ijsu.2022.106737.
8.	金涛, 黄伟, 夏庆. 急性胰腺炎早期液体复苏策略的现状与困惑—中西医结合认识汇通的启示. 中华胰腺病杂志, 2020, 20(5): 342-349.
9.	Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci, 2015, 22(6): 405-432.
10.	Pandanaboyana S, Huang W, Windsor JA, et al. Update on pain management in acute pancreatitis. Curr Opin Gastroenterol, 2022, 38(5): 487-494.
11.	Jabaudon M, Genevrier A, Jaber S, et al. Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial. Crit Care, 2023, 27(1): 213. doi: 10.1186/s13054-023-04502-w.
12.	易志忠, 陈国忠, 袁铁超, 等. 大承气汤治疗重症急性胰腺炎临床疗效的Meta分析. 中国中医急症, 2020, 29(8): 1370-1373.
13.	Zhang K, Gao C, Li C, et al. Acupuncture for acute pancreatitis: a systematic review and meta-analysis. Pancreas, 2019, 48(9): 1136-1147.
14.	Zhu F, Yin S, Zhu X, et al. Acupuncture for relieving abdominal pain and distension in acute pancreatitis: a systematic review and meta-analysis. Front Psychiatry, 2021, 12: 786401. doi: 10.3389/fpsyt.2021.786401.
15.	Li L, Jin T, Wen S, et al. Early rapid fluid therapy is associated with increased rate of noninvasive positive-pressure ventilation in hemoconcentrated patients with severe acute pancreatitis. Dig Dis Sci, 2020, 65(9): 2700-2711.
16.	Jaber S, Chanques G, Sebbane M, et al. Noninvasive positive pressure ventilation in patients with respiratory failure due to severe acute pancreatitis. Respiration, 2006, 73(2): 166-172.
17.	Zhao X, Huang W, Li J, et al. Noninvasive positive-pressure ventilation in acute respiratory distress syndrome in patients with acute pancreatitis: a retrospective cohort study. Pancreas, 2016, 45(1): 58-63.
18.	Khot Z, Murphy PB, Sela N, et al. Incidence of intra-abdominal hypertension and abdominal compartment syndrome: a systematic review. J Intensive Care Med, 2021, 36(2): 197-202.
19.	Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
20.	Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med, 2013, 39(7): 1190-1206.
21.	Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2): e1-e15.
22.	He K, Wang Y, Li J, et al. Neostigmine for non-mild acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol, 2023, 14: 1131974. doi: 10.3389/fphar.2023.1131974.
23.	He K, Yan X, Yang Z, et al. Neostigmine for the treatment of acute pancreatitis: a protocol for a systematic review and meta-analysis. BMJ Open, 2023, 13(3): e070289. doi: 10.1136/bmjopen-2022-070289.
24.	He W, Chen P, Lei Y, et al. Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis. Crit Care, 2022, 26(1): 52. doi: 10.1186/s13054-022-03922-4.
25.	秦百君, 陈月桥, 彭晓鹏, 等. 中药多途径治疗急性胰腺炎并发腹间隔室综合征疗效评价: 一项荟萃分析. 安徽医药, 2022, 26(12): 2333-2340.
26.	Vaughn VM, Shuster D, Rogers MAM, et al. Early versus delayed feeding in patients with acute pancreatitis: a systematic review. Ann Intern Med, 2017, 166(12): 883-892.
27.	Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol, 2006, 40(5): 431-434.
28.	Yang X, Shi N, Yao L, et al. Impact of admission and early persistent stress hyperglycaemia on clinical outcomes in acute pancreatitis. Front Endocrinol (Lausanne), 2022, 13: 998499. doi: 10.3389/fendo.2022.998499.
29.	He W, Cai W, Yang X, et al. Insulin or blood purification treatment for hypertriglyceridaemia-associated acute pancreatitis: a systematic review and meta-analysis. Pancreatology, 2022, 22(7): 846-857.
30.	Siriwardena AK, Jegatheeswaran S, Mason JM, et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol, 2022, 7(10): 913-921.
31.	Boxhoorn L, van Dijk SM, van Grinsven J, et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med, 2021, 385(15): 1372-1381.
32.	苗毅, 黄东亚, 李强等. 从“step-up”到“step-jump”—感染坏死性胰腺炎“跨阶梯”治疗. 中国实用外科杂志, 2020, 40(11): 1251-1254.
33.	Huang W, de la Iglesia-García D, Baston-Rey I, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci, 2019, 64(7): 1985-2005.

1. 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南 (2021). 中国实用外科杂志, 2021, 41(7): 739-746.
2. 金涛, 黄伟, 张潇颖, 等. 急性胰腺炎中西医结合诊疗指南. (2023-05-31). http://www.caim.org.cn/info_content.jsp?id=10322, 2023.5.31.
3. Zhou S, Buitrago C, Foong A, et al. Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis. Pancreatology, 2021, 21(8): 1405-1410.
4. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev, 2013(2): CD000567.
5. de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N Engl J Med, 2022, 387(11): 989-1000.
6. Jin T, Li L, Zhu P, et al. Optimising fluid requirements after initial resuscitation: a pilot study evaluating mini-fluid challenge and passive leg raising test in patients with predicted severe acute pancreatitis. Pancreatology, 2022, 22(7): 894-901.
7. Froghi F, Soggiu F, Ricciardi F, et al. Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial. Int J Surg, 2022, 104: 106737. doi: 10.1016/j.ijsu.2022.106737.
8. 金涛, 黄伟, 夏庆. 急性胰腺炎早期液体复苏策略的现状与困惑—中西医结合认识汇通的启示. 中华胰腺病杂志, 2020, 20(5): 342-349.
9. Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci, 2015, 22(6): 405-432.
10. Pandanaboyana S, Huang W, Windsor JA, et al. Update on pain management in acute pancreatitis. Curr Opin Gastroenterol, 2022, 38(5): 487-494.
11. Jabaudon M, Genevrier A, Jaber S, et al. Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial. Crit Care, 2023, 27(1): 213. doi: 10.1186/s13054-023-04502-w.
12. 易志忠, 陈国忠, 袁铁超, 等. 大承气汤治疗重症急性胰腺炎临床疗效的Meta分析. 中国中医急症, 2020, 29(8): 1370-1373.
13. Zhang K, Gao C, Li C, et al. Acupuncture for acute pancreatitis: a systematic review and meta-analysis. Pancreas, 2019, 48(9): 1136-1147.
14. Zhu F, Yin S, Zhu X, et al. Acupuncture for relieving abdominal pain and distension in acute pancreatitis: a systematic review and meta-analysis. Front Psychiatry, 2021, 12: 786401. doi: 10.3389/fpsyt.2021.786401.
15. Li L, Jin T, Wen S, et al. Early rapid fluid therapy is associated with increased rate of noninvasive positive-pressure ventilation in hemoconcentrated patients with severe acute pancreatitis. Dig Dis Sci, 2020, 65(9): 2700-2711.
16. Jaber S, Chanques G, Sebbane M, et al. Noninvasive positive pressure ventilation in patients with respiratory failure due to severe acute pancreatitis. Respiration, 2006, 73(2): 166-172.
17. Zhao X, Huang W, Li J, et al. Noninvasive positive-pressure ventilation in acute respiratory distress syndrome in patients with acute pancreatitis: a retrospective cohort study. Pancreas, 2016, 45(1): 58-63.
18. Khot Z, Murphy PB, Sela N, et al. Incidence of intra-abdominal hypertension and abdominal compartment syndrome: a systematic review. J Intensive Care Med, 2021, 36(2): 197-202.
19. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
20. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med, 2013, 39(7): 1190-1206.
21. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2): e1-e15.
22. He K, Wang Y, Li J, et al. Neostigmine for non-mild acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol, 2023, 14: 1131974. doi: 10.3389/fphar.2023.1131974.
23. He K, Yan X, Yang Z, et al. Neostigmine for the treatment of acute pancreatitis: a protocol for a systematic review and meta-analysis. BMJ Open, 2023, 13(3): e070289. doi: 10.1136/bmjopen-2022-070289.
24. He W, Chen P, Lei Y, et al. Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis. Crit Care, 2022, 26(1): 52. doi: 10.1186/s13054-022-03922-4.
25. 秦百君, 陈月桥, 彭晓鹏, 等. 中药多途径治疗急性胰腺炎并发腹间隔室综合征疗效评价: 一项荟萃分析. 安徽医药, 2022, 26(12): 2333-2340.
26. Vaughn VM, Shuster D, Rogers MAM, et al. Early versus delayed feeding in patients with acute pancreatitis: a systematic review. Ann Intern Med, 2017, 166(12): 883-892.
27. Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol, 2006, 40(5): 431-434.
28. Yang X, Shi N, Yao L, et al. Impact of admission and early persistent stress hyperglycaemia on clinical outcomes in acute pancreatitis. Front Endocrinol (Lausanne), 2022, 13: 998499. doi: 10.3389/fendo.2022.998499.
29. He W, Cai W, Yang X, et al. Insulin or blood purification treatment for hypertriglyceridaemia-associated acute pancreatitis: a systematic review and meta-analysis. Pancreatology, 2022, 22(7): 846-857.
30. Siriwardena AK, Jegatheeswaran S, Mason JM, et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol, 2022, 7(10): 913-921.
31. Boxhoorn L, van Dijk SM, van Grinsven J, et al. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med, 2021, 385(15): 1372-1381.
32. 苗毅, 黄东亚, 李强等. 从“step-up”到“step-jump”—感染坏死性胰腺炎“跨阶梯”治疗. 中国实用外科杂志, 2020, 40(11): 1251-1254.
33. Huang W, de la Iglesia-García D, Baston-Rey I, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci, 2019, 64(7): 1985-2005.

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Interpretation of 《Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis》

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