28 例急性胰腺炎的临床观察及护理

急性胰腺炎是指胰腺分泌的消化酶引起的胰腺组织自身消化的化学性炎症。临床主要表现为急性上腹痛、发热、恶心、呕吐血和尿淀粉酶增高,重症伴腹膜炎、休克等并发症。本科1998年-2005年10月共收治了急性胰腺炎病人28例,本文就急性胰腺炎的临床观察及护理作一探讨。     

76例急性胰腺炎护理体会

急性胰腺炎(acute pancreatitis,AP)是由各种致病因素所导致的胰酶在胰腺内被激活,从而引起胰腺自身组织和周围组织的消化、水肿、出血甚至坏死的炎性反应。临床上表现为急性上腹部的疼痛、恶心、呕吐、发热等症状,实验室检查发现血尿中的胰酶增高,B超及CT可见胰腺组织溶解改变等。     

慢性胰腺炎胰腺纤维化发病机制研究新进展

慢性胰腺炎(chronic pancreatitis, CP)是由多种因素引起的胰腺内外分泌功能紊乱,可导致胰腺结构和功能发生不可逆性损伤,是临床常见的消化系统疾病。CP的病理特点是腺泡细胞损伤导致巨噬细胞等多种炎症细胞浸润,从而分泌大量促炎细胞因子,在胰腺组织微环境中引起胰腺星状细胞活化,进而产生大量的细胞外基质,表现为胰腺纤维化。而新近的研究提示:胰腺纤维化是一种动态病理现象,需要由多种自分泌和旁分泌的细胞因子组成复杂的网络,作用于相应的信号通路,最终导致纤维化形成。现以CP胰腺组织微环境中出现的主要细胞,如胰腺星状细胞、巨噬细胞、腺泡细胞及其在CP胰腺纤维化进展中的变化和作用为切入点,对CP胰腺纤维化的发病机制研究进展做一综述。     

急性弥漫性轴索损伤CT与MRI对比的研究

目的:比较急性弥漫性轴索损伤患者CT及MRI表现的不同。方法:选取60例急性弥漫性轴索损伤患者,而CT无异常改变或改变轻微的病例行MRI检查。全部检查均在损伤后6天内完成。GCS评分＜8分44例,9—12分16例。结果:MRI显示具有DAI损伤表现的共41例,阳性率68．3%,其中单独具有DAIⅠ、Ⅱ和Ⅲ型损伤表现的分别为7例、12例和1例,同时具有DAIⅠ和Ⅱ型损伤表现的共12例,同时具有DAJⅠ和Ⅲ型损伤表现的共2例,同时具有DAJⅡ和Ⅲ型损伤表现的共2例,同时具有三型DAI损伤表现的共5例;CT显示具有DAI损伤表现的共3例,阳性率5．0%,其中具有DAIⅠ型损伤表现的2例,具有DAIⅡ型损伤表现的1例,具有DAIⅢ型损伤表现的0例。结论:CT缺乏异常表现或轻微异常表现的急性弥漫性轴索损伤,MRI常常能显示损伤,包括特殊的损伤部位和一些其他类型合并损伤。     

趋化因子及趋化因子受体在急性胰腺炎中的研究进展

普遍认为,急性胰腺炎起始于腺泡细胞内的胰蛋白酶原激活,随后引起的炎症反应加剧病情,也是多器官功能衰竭的主要原因。然而,最新的研究表明,急性胰腺炎引起的炎症反应是不依赖于胰蛋白酶原激活的独立病理过程。趋化因子作为能引起细胞趋化的细胞因子,通过与趋化因子受体作用,不但能调控淋巴细胞的生长、成熟和迁移,也参与多种炎症疾病与癌症的病理过程。近年来,多项研究已经阐述趋化因子及趋化因子受体在急性胰腺炎的发病发展过程中起到至关重要的作用。本文总结了CC,CXC和CX3C趋化因子家族成员在参与急性胰腺炎的炎症反应及对胰腺损伤的修复的研究进展,这将为AP临床治疗方案的设计提供新思路。     

急性胰腺炎患者的CT、MRI影像学表现及其诊断价值对比研究

摘要 目的：比较急性胰腺炎患者的电子计算机断层扫描（CT）、磁共振成像（MRI）影像学表现及其诊断价值。方法：选择2018年1月-2019年12月我院收治并初步诊断为急性胰腺炎的患者124例，所有患者均同时行CT和MRI检查，并比较两种检查方式诊断急性胰腺炎的影像学表现，以临床最终诊断结果作为参考，比较两种检查方式诊断急性胰腺炎的价值。结果：124例患者，经临床最终诊断为急性胰腺炎96例，28例为非急性胰腺炎，以临床最终诊断结果为"金标准"，CT诊断急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为84.38%、75.00%、92.05%、58.33%、82.26%，MRI诊断急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为95.83%、78.57%、93.88%、84.62%、91.94%，MRI诊断急性胰腺炎的灵敏度、阴性预测值和准确度显著高于CT（P<0.05），两种检查方式诊断急性胰腺炎的特异度、阳性预测值比较无统计学差异（P>0.05）。结论：CT和MRI影像学表现有利于急性胰腺炎的诊断，两者对急性胰腺炎诊断均具有较高的灵敏度、特异度和准确度， 但MRI诊断急性胰腺炎的灵敏度、准确度优于CT。     

胰腺神经内分泌肿瘤的不典型CT、MRI征象分析

目的:分析4例胰腺神经内分泌肿瘤(P-NENs)的不典型CT、MRI影像学特征,以提高对其诊断水平.方法:对4例经手术病理证实的P-NENs的不典型CT和(或)MRI表现进行回顾性分析.结果:4例胰腺神经内分泌肿瘤患者均进行CT平扫及增强检查,平扫病变相对于正常胰腺呈等密度1例,稍低密度3例,其中1例瘤内见钙化;CT增强扫描4例均为轻～中度增强,静脉期较动脉期增强幅度稍减低,所有患者各期增强幅度均未超过胰腺实质,其中1例可见延迟期不完整包膜强化,包膜密度略高于周围胰腺.3例患者行MRI平扫、DWI及增强检查,2例肿瘤相对正常胰腺呈长T1、稍长T2信号,较均匀,1例T1WI呈不均匀稍低信号,T2WI呈较高与稍低混杂信号,CT所显示之病变内钙化T1、T2均呈较低信号.DWI序列3例病变均呈较明显高信号.增强扫描3例病变均呈轻到中度强化,2例强化较均匀,1例强化不均匀,强化幅度均未超过正常胰腺.2例MRI可见有部分包膜环形强化,略高于周围胰腺实质.结论:明显增强以及包膜强化被认为是P-NENs的典型影像学表现,但其影像学表现多样,认识其多样性及不典型影像学征象,可以提高对其诊断准确率.     

雨蛙素联合脂多糖致小鼠重症急性胰腺炎模型的建立及其机理的探讨

为建立一种快速、简便、无创伤性的小鼠重症急性胰腺炎模型。本实验运用雨蛙素联合脂多糖小鼠腹腔内给药;血淀粉酶和胰腺湿重测定;胰腺和胰外器官病理学检查;腺泡细胞透射电镜观察;血清NO浓度测定;胰腺组织SOD和MDA测定。结果发现,雨蛙素联合脂多糖组血淀粉酶、NO浓度和胰腺湿重均增高,SOD活力降低,MDA含量升高,胰腺间质水肿、实质出血坏死、炎症细胞浸润,腺泡细胞受损严重,胰外多器官受到不同程度的损害;雨蛙素组胰腺无明显出血坏死,胰外器官正常;脂多糖组胰腺基本正常,胰外器官轻微炎症浸润。由本实验结果显示,雨蛙素联合脂多糖致小鼠重症急性胰腺炎模型具有人类重症急性胰腺炎的病理特征,为非创伤性,成模快速稳定,重复性好;脂多糖促使雨蛙素诱导的急性水肿型胰腺炎重症化的机理与自由基释放-清除机制和氧化-抗氧化机制紊乱有关。     

急性胰腺炎营养支持的现状及意义

急性胰腺炎是常见外科急腹癌,其治疗方法包括胃肠减压,禁食,抗炎,抑酸,补液营养支持治疗.营养支持治疗使胰腺充分休息,在急性胰腺炎治疗中具有重要作用,营养支持治疗分为肠内营养和肠外营养.经过多年临床实践与研究,肠内营养和肠外营养的应用已相当广泛,其效果各有利弊.本文将对急性胰腺炎的肠内营养和肠外营养加以论述.     

急性胰腺炎患者肾功能和血糖改变的分析和研究

急性胰腺炎 ( Acute pancreatitis,AP)特别是出血坏死性胰腺炎除可引起胰腺本身代谢异常外 ,常合并其它重要脏器和全身代谢紊乱等并发症。对AP并发症的认识与正确治疗、提高治愈率有重要意义。本文着重对 90例 AP患者肾功能和血糖的变化进行分析、研究。现报告如下。1　临床资料1 .1　一般资料　本组 90例中 ,男 36例 ,女 5 4例 ,男 :女 =1 :1 .64。年龄 1 6～ 82岁 ,平均 49岁。 AP诊断标准 :( 1 )突然发作性上腹部或左上腹疼痛 ;( 2 )上腹部有明显压痛和不同程度肌紧张 ,血白细胞数增加 ;( 3)血、尿淀粉酶高于正常 ;( 4 ) B超或 CT证…     

Vildagliptin-Induced Acute Pancreatitis

ObjectiveTo describe the first reported case of acute pancreatitis in a patient receiving vildagliptin.MethodsWe present the clinical, biochemical, and radiographic findings of the study patient.ResultsA 61-year-old woman who presented with severe abdominal pain was found to have acute pancreatitis. This occurred 5 weeks after the commencement of vildagliptin, a dipeptidyl-peptidase 4 inhibitor, for the treatment of type 2 diabetes mellitus. The patient’s pancreatic enzymes were elevated (amylase, 1205 U/L; lipase, 8846 U/L), and abdominal computed tomography demonstrated diffuse pancreatic swelling, cyst formation, and necrosis in the body of the pancreas. In the absence of an identifiable cause for the patient’s pancreatitis, vildagliptin was considered a potential trigger. The patient recovered after vildagliptin therapy was ceased.ConclusionsAlthough incretin-based therapy effectively treats type 2 diabetes mellitus, emerging reports of acute pancreatitis in patients receiving sitagliptin and exenatide have prompted the US Food and Drug Administration to issue an alert on these drugs. This appears to be the first reported case of acute pancreatitis in a patient receiving vildagliptin, and it supports the possibility that acute pancreatitis may be a rare effect of incretin-based therapy.(Endocr Pract. 2011;17:e48-e50)     

Conditional generative adversarial networks to generate pseudo low monoenergetic CT image from a single-tube voltage CT scanner

PurposeTo generate pseudo low monoenergetic CT images of the abdomen from 120-kVp CT images with cGAN.Materials and MethodsWe retrospectively included 48 patients who underwent contrast-enhanced abdominal CT using dual-energy CT. We reconstructed paired data sets of 120 kVp CT images and virtual low monoenergetic (55-keV) CT images. cGAN was prepared to generate pseudo 55-keV CT images from 120-kVp CT images. The pseudo 55 keV CT images in epoch 10, 50, 100, and 500 were compared to the 55 keV images generated using peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM).ResultsThe PSNRs were 28.0, 28.5, 28.6, and 28.8 at epochs 10, 50, 100, and 500, respectively. The SSIM was approximately constant from epochs 50 to 500.ConclusionPseudo low monoenergetic abdominal CT images were generated from 120-kVp CT images using cGAN, and the images had good quality similar to that of monochromatic images obtained with DECT software.     

Visualization of the left extraperitoneal space and spatial relationships to its related spaces by the visible human project

Background

The major hindrance to multidetector CT imaging of the left extraperitoneal space (LES), and the detailed spatial relationships to its related spaces, is that there is no obvious density difference between them. Traditional gross anatomy and thick-slice sectional anatomy imagery are also insufficient to show the anatomic features of this narrow space in three-dimensions (3D). To overcome these obstacles, we used a new method to visualize the anatomic features of the LES and its spatial associations with related spaces, in random sections and in 3D.

Methods

In conjunction with Mimics® and Amira® software, we used thin-slice cross-sectional images of the upper abdomen, retrieved from the Chinese and American Visible Human dataset and the Chinese Virtual Human dataset, to display anatomic features of the LES and spatial relationships of the LES to its related spaces, especially the gastric bare area. The anatomic location of the LES was presented on 3D sections reconstructed from CVH2 images and CT images.

Principal Findings

What calls for special attention of our results is the LES consists of the left sub-diaphragmatic fat space and gastric bare area. The appearance of the fat pad at the cardiac notch contributes to converting the shape of the anteroexternal surface of the LES from triangular to trapezoidal. Moreover, the LES is adjacent to the lesser omentum and the hepatic bare area in the anterointernal and right rear direction, respectively.

Conclusion

The LES and its related spaces were imaged in 3D using visualization technique for the first time. This technique is a promising new method for exploring detailed communication relationships among other abdominal spaces, and will promote research on the dynamic extension of abdominal diseases, such as acute pancreatitis and intra-abdominal carcinomatosis.     

Elimination of biological and physical artifacts in abdomen and brain computed tomography procedures using filtering techniques

IntroductionMedical images are usually affected by biological and physical artifacts or noise, which reduces image quality and hence poses difficulties in visual analysis, interpretation and thus requires higher doses and increased radiographs repetition rate.ObjectivesThis study aims at assessing image quality during CT abdomen and brain examinations using filtering techniques as well as estimating the radiogenic risk associated with CT abdomen and brain examinations.Materials and MethodsThe data were collected from the Radiology Department at Royal Care International (RCI) Hospital, Khartoum, Sudan. The study included 100 abdominal CT images and 100 brain CT images selected from adult patients. Filters applied are namely: Mean filter, Gaussian filter, Median filter and Minimum filter. In this study, image quality after denoising is measured based on the Mean Squared Error (MSE), Peak Signal-to-Noise Ratio (PSNR), and the Structural Similarity Index Metric (SSIM).ResultsThe results show that the images quality parameters become higher after applications of filters. Median filter showed improved image quality as interpreted by the measured parameters: PSNR and SSIM, and it is thus considered as a better filter for removing the noise from all other applied filters.DiscussionThe noise removed by the different filters applied to the CT images resulted in enhancing high quality images thereby effectively revealing the important details of the images without increasing the patients’ risks from higher doses.ConclusionsFiltering and image reconstruction techniques not only reduce the dose and thus the radiation risks, but also enhances high quality imaging which allows better diagnosis.     

生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响

目的:探究生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响。方法:选取2015年8月～2018年8月我院收治的急性胰腺炎患者98例,根据患者入院先后顺序分为两组。对照组患者给予生长抑素治疗,观察组在对照组的基础上联合双歧杆菌四联活菌片治疗。比较两组患者的临床治疗效果,临床症状和指标的恢复时间及胃肠动力的恢复情况,治疗前后D-乳酸、二胺氧化酶(DAO)和尿乳果糖和甘露醇的比值(L/M)水平的变化。结果:治疗后,观察组患者的总有效率显著高于对照组(P0.05),腹痛、腹胀、腹膜刺激征、血淀粉酶和尿淀粉酶恢复正常时间均显著短于对照组(P0.05)。治疗后,两组患者的血清D-乳酸、DAO和L/M水平均较治疗前显著下降,且观察组以上指标均显著低于对照组(P0.05)。此外,观察组患者的腹内压显著低于对照组,肠鸣音恢复时间显著短于对照组,胃肠减压引流量显著低于对照组(P0.05)。结论:与单用生长抑素相比,生长抑素联合双歧杆菌四联活菌可更迅速缓解急性胰腺炎患者的临床症状及指标,恢复胃肠动力,并显著改善患者的肠粘膜屏障功能,利于患者的康复。     

Perfusion-CT - Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

Purpose

Severe acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.

Material and Methods

79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4–6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient''s clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.

Results

Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.

Conclusions

CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.     

Anatomic Pathways of Peripancreatic Fluid Draining to Mediastinum in Recurrent Acute Pancreatitis: Visible Human Project and CT Study

Background

In past reports, researchers have seldom attached importance to achievements in transforming digital anatomy to radiological diagnosis. However, investigators have been able to illustrate communication relationships in the retroperitoneal space by drawing potential routes in computerized tomography (CT) images or a virtual anatomical atlas. We established a new imaging anatomy research method for comparisons of the communication relationships of the retroperitoneal space in combination with the Visible Human Project and CT images. Specifically, the anatomic pathways of peripancreatic fluid extension to the mediastinum that may potentially transform into fistulas were studied.

Methods

We explored potential pathways to the mediastinum based on American and Chinese Visible Human Project datasets. These drainage pathways to the mediastinum were confirmed or corrected in CT images of 51 patients with recurrent acute pancreatitis in 2011. We also investigated whether additional routes to the mediastinum were displayed in CT images that were not in Visible Human Project images.

Principal Findings

All hypothesized routes to the mediastinum displayed in Visible Human Project images, except for routes from the retromesenteric plane to the bilateral retrorenal plane across the bilateral fascial trifurcation and further to the retrocrural space via the aortic hiatus, were confirmed in CT images. In addition, route 13 via the narrow space between the left costal and crural diaphragm into the retrocrural space was demonstrated for the first time in CT images.

Conclusion

This type of exploration model related to imaging anatomy may be used to support research on the communication relationships of abdominal spaces, mediastinal spaces, cervical fascial spaces and other areas of the body.     

影响急性重症胰腺炎患者死亡的危险因素分析

目的:分析影响急性重症胰腺炎患者死亡的危险因素,为临床防治提供依据。方法:回顾性分析我院2014年11月至2018年10月收治的101例急性重症胰腺炎患者临床资料,根据其治疗结局将其分为生存组(好转出院)82例和死亡组(住院期间死亡)19例,分析影响急性重症胰腺炎患者死亡的危险因素。结果:单因素分析显示:死亡组Ranson评分、急性生理与慢性健康评分(APACHE-II)、CT严重指数(CTSI)、病因、血钙(Ca)、血清白蛋白(ALB)、血糖、血肌酐(Cr)、血尿素氮(BUN)、谷草转氨酶(AST)、上消化道出血发生率、胸腔积液发生率、脓毒血症发生率、休克发生率、多器官功能衰竭发生率与生存组比较差异均有统计学意义(P0.05)。多因素logistic回归分析显示:APACHE-II评分、血糖、Cr、BUN、脓毒血症、休克、多器官功能衰竭是急性重症胰腺炎患者死亡独立危险因素(P0.05),Ca、ALB是其保护因素(P0.05)。结论:影响急性重症胰腺炎患者死亡危险因素包括APACHE-II评分、FPG、Cr、BUN、AST、脓毒血症、休克、多器官功能衰竭,保护因素包括Ca、ALB。