【摘要】 目的 探讨比较全肠内营养支持和全肠外营养支持对急性重症胰腺炎（severe acute pamcreattis，SAP）预后的影响。 方法 将2003年1月-2008年12月收治的54例SAP患者于入院后第1周内随机分为两组:全肠内营养（A）组27例；全肠外营养（B）组27例。两组患者均静脉给予广谱抗生素预防感染。入院时CT扫描及C反应蛋白水平显示两组患者具有可比性。 结果 B组22例患者发生器官衰竭，明显高于A组（5例）。B组22例患者接受了手术治疗，A组手术患者6例（Plt;0.05）。A组患者胰腺坏死后感染发生率明显低于B组（Plt;0.05）。B组患者死亡率高于A组（Plt;0.05）。 结论 全肠内营养支持，不仅可以促进肠道功能的恢复和营养状况的维持，还可减少肠源性感染的发生率，对减少SAP的感染性并发症和病死率具有积极作用。【Abstract】 Objective To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP). Methods A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups. Results Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05). Conclusion Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.
目的了解重症急性胰腺炎（SAP）并发症与病死率的关系。方法对19年来我院肝胆外科收治的112例SAP患者进行回顾性总结分析。结果112例中，治愈92例（82.1%），死亡20例（17.9%），发生各种并发症73例（65.2%）。手术治疗73例（65.2%），治愈58例（79.5%），死亡15例（20.5%）。非手术治疗39例（34.8%），治愈34例（87.2%），死亡5例（12.8%）。手术治疗组和非手术治疗组间治愈率和死亡率差异无统计学意义（Pgt;0.05）。与病死率有关的并发症为休克、肺功能不全、胰性脑病和全身感染，其病死率分别为7.1%、6.3%、5.4%和3.6%。SAP并发症综合评分大于7分组和小于7分组比较，病死率差异有显著性意义（P＜0.01）。结论SAP患者是死于其并发症，而并发症中休克、肺功能不全、胰性脑病和全身感染是致死的最主要原因。
Ｔｏ ｆｉｎｄ ｏｕｔ ｔｈｅ ａｐｐｒｏｐｒｉａｔｅ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｆｏｒ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ａｎｄ ａｐｐｌｙ ｉｔ ｔｏ ｔｈｅ ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ｏｆ ｐａｔｉｅｎｔ ｗｉｔｈ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ ａｒｅ ｒｅｐｏｒｔｅｄ．Ａｂｄｏｍｉｎａｌ ｔｕｂｅ ｗａｓ ｉｎｓｅｒｔｅｄ ｔｏ ｒａｂｂｉｔ ｆｏｒ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｍｏｎｉｔｏｒｉｎｇ ａｎｄ ａｎｏｔｈｅｒ ｔｕｂｅ ｗａｓ ｃｕｓｅｒｔｅｄ ｉｎｔｏ ｔｈｅ ａｂｄｏｍｅｎ ｆｏｒ ｃｏｎｔｉｎｕｏｕｓ ｎｏｒｍａｌ ｓａｌｉｎｅ ｉｎｓｔｉｌｌａｔｉｏｎ．Ｔｈｅ ｒｅｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｄｒａｉｎａｇｅ ｆｌｕｉｄ ｕｎｄｅｒ ｄｉｆｆｅｒｅｎｔ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｗｅｒｅ ｍｅａｓｕｒｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｆｌｕｉｄ ｄｅｐｌｅｔｉｏｎ ｒａｔｅ（７０％）ｏｆ ｔｈｅ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｇｒｏｕｐ（１．５ ｋＰａ）ｗａｓ ｈｉｇｅｈｅｒ ｔｈａｎ ｔｈａｔ ｏｔｈｅｒ ｉｎ ３ ｇｒｏｕｐｓ（ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ０ ｋＰａ，５ ｋＰａ ａｎｄ １５ ｋＰａ）（Ｐ＜０．０１）．Ｗｉｔｈ ｔｈｉｓ ｃｏｎｔｉｎｕｏｕｓ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｉｎ ２０ ｐａｔｉｅｎｔｓ ａｆｔｅｒ ｓｅｖｅｒｅ ｐａｎｃｒｅａｔｉｔｉｓ ｏｐｅｒａｔｉｏｎ，ｗｅ ｆｏｕｎｄ ｔｈａｔ ｔｈｉｓ ｍｅｔｈｏｄ ｈａｖｅ ｍｏｒｅ ａｄｖａｎｔａｇｅｓ ｏｆ ｒｅｄｕｃｉｎｇ ｃｏｍｐｌｉｃａｔｉｏｎ，ｐｒｏｍｏｔｉｎｇ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｄｕｃｉｎｇ ｄｅａｔｈ ｒａｔｅ．
目的 探讨护理行为对重症急性胰腺炎患者在实时强化血糖控制和治疗中的效果与影响。 方法 选择2010年7月－2011年7月15例采用强化血糖控制研究的急性重症胰腺炎患者，对其实时24 h动态血糖监测的护理方法及要点进行回顾分析。 结果 15例患者顺利完成强化血糖控制的临床研究，血糖值达到目标监测范围（6.1～8.3 mmol/L）的百分比例78.3%，未出现严重并发症。 结论 实时动态的血糖监测、严格执行的强化血糖控制方案及针对性护理措施可为重症胰腺炎患者的血糖强化控制提供安全有效的保证。
目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
ObjectiveTo discuss the change of expression of Na-K-ATPase mRNA in the rats with severe acute pancreatitis (SAP). MethodsTwenty four SPF SD rats were randomly divided into sham group (n=6) and SAP group (n=18), the experiment concluded 3 sub-experiments, and each sub-experiments enrolled 24 rats. After establishment of SAP model successfully, rats of SAP group were randomly divided into SAP-4 h group (n=6), SAP-24 h group (n=6), and SAP-48 h group (n=6). Rats of sham group were only conducted the abdominal exploration. Rats of 4 groups were sacrificed (sham group:4 hours after surgery; SAP-4 h group:4 hours after surgery; SAP-24 h group:24 hours after surgery; SAP-48 h group:48 hours after surgery) to determine the dry/wet ratio, alveolar fluid clearance (AFC), and expressions of Na-K-ATPase mRNA at 2 sides of lung tissues. Results① Dry/wet ratio. Compared with sham group, the dry/wet ratios of SAP-4 h group, SAP-24 h group, and SAP-48 h group were all lower (P < 0.01); compared with SAP-4 h group, the dry/wet ratio of SAP-24 h group was lower (P < 0.01), but dry/wet ratio of SAP-48 h group was higher (P < 0.01); compared with SAP-24 h group, dry/wet ratio of SAP-48 h group was higher (P < 0.01). ② AFC. Compared with sham group, the AFC value of SAP-4 h group and SAP-24 h group were both higher (P < 0.01), but there was no significant difference between sham group and SAP-48 h group (P > 0.05); compared with SAP-4 h group, the AFC value of SAP-24 h group and SAP-48 h group were both lower (P < 0.01); compared with SAP-24 h group, the AFC value of SAP-48 h group was lower (P < 0.01). ③ α1 Na-K-ATPase mRNA. Compared with corresponding side of lung tissue in sham group, the expression level of α1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-4 h group, SAP-24 h group, and SAP-48 h group were higher (P < 0.01); compared with corresponding side of lung tissue in SAP-4 h group, the expression level of α1 Na-K-ATPase mRNA was lower at left lung tissue (P < 0.05) and was higher at right lung tissue (P < 0.01) in SAP-24 h group, and expression level of α1 Na-K-ATPase mRNA at both sides of lung tissues was lower in SAP-48 h group (P < 0.01); compared with corresponding side of lung tissue in SAP-24 h group, the expression level of α1 Na-K-ATPase mRNA at both 2 sides of lung tissues was lower in SAP-48 h group (P < 0.01). There was no significant difference in the expression level of α1 Na-K-ATPase mRNA between left lung tissue and right lung tissue in sham group, SAP-4 h group, and SAP-48 h group (P > 0.05), but the expression level of α1 Na-K-ATPase mRNA at right lung tissue was higher than that of left lung tissue in SAP-24 h group (P < 0.01). ④ β1 Na-K-ATPase. Compared with corresponding side of lung tissue in sham group, the expression level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-4 h group, SAP-24 h group, and SAP-48 h group was higher (P < 0.01); compared with corresponding side of lung tissue in SAP-4 h group, the expres-sion level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-24 h group was higher (P < 0.01), and lower in right lung tissue of SAP-48 h group (P < 0.01); compared with corresponding side of lung tissue in SAP-24 h group, the expression level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues was lower in SAP-48 h group (P < 0.01). There was no significant difference in the expression level of β1 Na-K-ATPase mRNA between left lung tissue and right lung tissue in sham group and SAP-48 h group (P > 0.05), but the expression level of β1 Na-K-ATPase mRNA at right lung tissue was higher than that of left lung tissue in SAP-4 h and SAP-24 h group (P < 0.05). Conclusionα1 Na-K-ATPase mRNA may be the key factor for AFC, and may involved in the water transformation in lung tissue of SD rat with SAP.