Protective Strategies for Organ Function of Fulminant Acute Pancreatitis in Early Stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Hong , LI Fei , ZHU Yan , JIA Jianguo , SUN Jiabang.

Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China;

Corresponding author：

Keywords：

Acute pancreatitis; Treatment; Multiple organ dysfunction syndrome

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ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.

Citation： CHEN Hong,LI Fei,ZHU Yan,JIA Jianguo,SUN Jiabang.. Protective Strategies for Organ Function of Fulminant Acute Pancreatitis in Early Stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 250-254. doi: Copy

1.	孙家邦, 朱斌. 暴发性胰腺炎的诊断及治疗 [J]. 中国实用外科杂志, 2004, 24(1): 2324.
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6.	Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome [J]. Crit Care Med, 1995, 23(10): 16381652.
7.	Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit [J]. N Engl J Med, 2004, 350(22): 22472256.
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10.	Cheatham ML. Abdominal compartment syndrome [J]. Curr Opin Crit Care, 2009, 15(2): 154162.
11.	De Waele JJ, Leppniemi AK. Intraabdominal hypertension in acute pancreatitis [J]. World J Surg, 2009, 33(6): 11281133.
12.	Chen H, Li F, Sun JB, et al. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage [J]. World J Gastroenterol, 2008, 14(22): 35413548.
13.	Chen H, Li F, Jia JG, et al. Effects of traditional Chinese medicine on intestinal mucosal permeability in early phase of severe acute pancreatitis [J]. Chin Med J (Engl), 2010, 123(12): 15371542.
14.	刁永鹏, 李非, 陈宏, 等. 理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响 [J]. 中国普外基础与临床杂志, 2009, 16(8): 637640.
15.	Lobo DN, MemonMA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000, 87(6): 695707.
16.	陈宏, 贾建国, 李非, 等. 肠内营养对重症急性胰腺炎预后的影响 [J]. 中国临床营养杂志, 2006, 14(1): 3739.
17.	董亮, 康焰. 早期肠内营养在重症急性胰腺炎治疗中的应用 [J]. 中国普外基础与临床杂志, 2008, 15(8): 567571.
18.	Vieira JP, de Araújo GF, de Azevedo JR, et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis [J]. Acta Cir Bras, 2010, 25(5): 449454.
19.	Krska Z, Sváb J. Fulminant acute pancreatitis [J]. Rozhl Chir, 2009, 88(10): 563567.
20.	Nathens AB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis [J]. Crit Care Med, 2004, 32(12): 25242536.
21.	李非, 陈宏, 杨磊, 等. 重症急性胰腺炎早期脏器功能不全持续时间与治疗对策 [J]. 中华外科杂志, 2007, 45(11): 762766.
22.	Talukdar R, Vege SS. Recent developments in acute pancreatitis [J]. Clin Gastroenterol Hepato, 2009, 7(Suppl): S3S9.

1. 孙家邦, 朱斌. 暴发性胰腺炎的诊断及治疗 [J]. 中国实用外科杂志, 2004, 24(1): 2324.
2. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup [J]. Pancreas, 2001, 22(3): 274278.
3. 姚榛祥. 重视暴发性胰腺炎的早期诊断与治疗 [J]. 中国普外基础与临床杂志， 2005, 12(5): 425427.
4. 中华医学会外科学分会胰腺外科学组. 重症急性胰腺炎诊治草案 [J]. 中华普通外科杂志, 2001, 16(11): 699700.
5. Dellinger R, Carlet M, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock [J]. Crit Care Med, 2004, 32(3): 858873.
6. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome [J]. Crit Care Med, 1995, 23(10): 16381652.
7. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit [J]. N Engl J Med, 2004, 350(22): 22472256.
8. 陈宏, 李非, 杨磊, 等. 重症急性胰腺炎并发急性呼吸窘迫综合征的临床特点分析 [J]. 中国危重病急救医学, 2005, 17(6): 375376.
9. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the international conference of experts on intraabdominal hypertension and abdominal compartment syndrome. Ⅰ. definitions [J]. Intensive Care Med, 2006, 32(11): 17221732.
10. Cheatham ML. Abdominal compartment syndrome [J]. Curr Opin Crit Care, 2009, 15(2): 154162.
11. De Waele JJ, Leppniemi AK. Intraabdominal hypertension in acute pancreatitis [J]. World J Surg, 2009, 33(6): 11281133.
12. Chen H, Li F, Sun JB, et al. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage [J]. World J Gastroenterol, 2008, 14(22): 35413548.
13. Chen H, Li F, Jia JG, et al. Effects of traditional Chinese medicine on intestinal mucosal permeability in early phase of severe acute pancreatitis [J]. Chin Med J (Engl), 2010, 123(12): 15371542.
14. 刁永鹏, 李非, 陈宏, 等. 理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响 [J]. 中国普外基础与临床杂志, 2009, 16(8): 637640.
15. Lobo DN, MemonMA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000, 87(6): 695707.
16. 陈宏, 贾建国, 李非, 等. 肠内营养对重症急性胰腺炎预后的影响 [J]. 中国临床营养杂志, 2006, 14(1): 3739.
17. 董亮, 康焰. 早期肠内营养在重症急性胰腺炎治疗中的应用 [J]. 中国普外基础与临床杂志, 2008, 15(8): 567571.
18. Vieira JP, de Araújo GF, de Azevedo JR, et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis [J]. Acta Cir Bras, 2010, 25(5): 449454.
19. Krska Z, Sváb J. Fulminant acute pancreatitis [J]. Rozhl Chir, 2009, 88(10): 563567.
20. Nathens AB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis [J]. Crit Care Med, 2004, 32(12): 25242536.
21. 李非, 陈宏, 杨磊, 等. 重症急性胰腺炎早期脏器功能不全持续时间与治疗对策 [J]. 中华外科杂志, 2007, 45(11): 762766.
22. Talukdar R, Vege SS. Recent developments in acute pancreatitis [J]. Clin Gastroenterol Hepato, 2009, 7(Suppl): S3S9.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Protective Strategies for Organ Function of Fulminant Acute Pancreatitis in Early Stage

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