血液滤过治疗急性出血性坏死性胰腺炎25例观察

1998～ 2 0 0 1年 ,我们在内科常规治疗的基础上 ,采用血液滤过 (Hemofiltration,HF)治疗急性出血坏死性胰腺炎 2 5例 ,并对其进行疗效观察 ,现将结果报告如下。1　临床资料1 .1　病例选择　 2 5例急性出血坏死性胰腺炎患者 ,男 1 4例 ,女 1 1例 ;年龄 2 9～ 6 4岁 ,平均 3 8.9岁。诊断符合 1 996年中华医学会外科学会胰腺学组委会修订的出血坏死性胰腺炎临床分型及诊断标准。 2 5例患者临床症状、体征、实验室检查资料见表 1 ,以 1 996～ 1 997年收治的 ,未采用血液滤过治疗的患者 1 5例 ,作为对照组。表 1　 2 5例患者临床症状及体征、…     

益生菌联合早期肠内营养治疗重症急性胰腺炎临床疗效的Meta分析

目的 系统性评价益生菌联合早期肠内营养对重症急性胰腺炎(sever acute pancreatitis,SAPP)的临床疗效.方法 计算机检索中国知网、万方数据库、维普期刊数据库、PubMed、Embase和The Co-chrane Library,收集关于益生菌联合早期肠内营养治疗SAP的临床随机对照试验(ran...     

连续性血液净化治疗重症急性胰腺炎38例患者的疗效观察

目的:研究连续性血液净化治疗重症急性胰腺炎的临床疗效;方法:选择选择2011年10月~2013年10月在我院接受治疗的重症急性胰腺炎患者38例,进行连续性血液净化治疗,检测患者治疗前后临床症状、体征、血液生化指标、细胞因子等,指标,并对患者治疗前后进行SOFA、MODS与APACHII评分;结果:38例患者31例治愈出院,治愈率为78.16%,无效死亡6例,死亡率15.79%。发生酸中毒、低血氧症、高钾血症的患者均全部得到纠正,发生酸中毒患者治疗前后pH值、HCO3-变化比较具有统计学意义(p0.01),其详细情况如表1;发生低血氧症患者治疗前后动脉血氧分压比较具有统计学意义(p0.01)。治疗前血液生化指标、血清细胞因子变化以及SOFA、MODS、APACHII评分比较,均具有统计学意义(p0.01或p0.05);结论:连续性血液净化治疗重症急性胰腺炎疗效显著,值得应用于临床。     

利福平致急性肾功能衰竭经腹膜透析治疗16例报告

我们用腹膜透析方法治疗利福平致急性肾功能衰竭患者 1 6例 ,效果满意 ,现报告如下。1　临床资料1 .1　一般资料　本组男 1 4例 ,女 2例 ;年龄最小36岁 ,最大 68岁 ,平均 44岁。服利福平片 4例 ,服肠炎灵胶囊 1 2例 ,(肠炎灵主要成分为利福平 )。第 2次服药发病 1 1例 ,第 3次服药发病 5例 ,其中在第 2次服药时均有不同程度过敏反应即停药 ,并经对症治疗而痊愈。既往有急性肾炎病史 2例 ,(均已治愈 )。距首次服用利福平或肠炎灵间隔时间为 5～ 2 4年 ,发病服药剂量均为首剂 2片或 2～4粒。所有病例均有不同程度恶心、呕吐、少尿、无尿、浮肿…     

连续性血液净化治疗重症急性胰腺炎的临床疗效分析

目的:探讨连续性血液净化治疗重症急性胰腺炎的临床疗效及安全性。方法:选取60例重症急性胰腺炎患者并随机分为两组,观察组(31例)给予连续血液净化治疗,对照组(29例)给予常规治疗。检测盒比较两组治疗前后C反应蛋白(CRP)、谷丙转氨酶(ALT)、氧合指数(PaO_2/FiO_2)、碳酸氢根离子(HCO_3~-)、血肌酐(Scr)水平、急性生理与慢性健康评分(APACHEⅡ)和多器官功能障碍综合征评分(MODS评分)及治疗期间并发症的发生情况和存活情况。结果:治疗后,两组CRP、ALT、HCO3~-、Scr水平均明显下降,PaO_2/FiO_2水平明显升高(P0.05),且观察组CRP、ALT、HCO_3~-、Scr水平低于对照组,而PaO_2/FiO_2水平高于对照组(P0.05)。治疗后,两组APACHEⅡ和MODS评分均较治疗前有所下降,且观察组分值明显低于对照组(P0.05)。两组治疗期间并发症发生率和存活率比较差异无统计学意义(P0.05)。结论:连续性血液净化治疗对重症急性胰腺炎具有较好的治疗效果,能显著改善多器官功能,降低体内炎症反应,调节水电解质平衡,治疗具有较高的安全性。     

不同时间早期肠内营养对急性重症胰腺炎患者的影响

目的:通过观察不同时间早期肠内营养对急性重症胰腺炎患者的影响,探讨急性重症胰腺炎患者早期肠内营养的最佳时机。方法:将重症急性胰腺炎患者60例分为三组:A组、B组和C组,每组20例。A组为肠外营养组予以常规治疗,B组在常规治疗的基础上通过鼻空肠管在入院3-5天内予以早期肠内营养,C组在常规治疗的基础上通过鼻空肠管在入院5天后予以早期肠内营养。抽取所有患者入院时、入院后3天、7天、14天静脉血,ELISA法测定患者血清中TNF-α、IL-6含量,并记录患者住院期间感染率、病死率、并发症发生率、住院时间、住院费用等。结果:各组患者血清中TNF-α、IL-6含量逐渐下降,B组和C组下降较A组下降明显,差异有统计学意义(P<0.05),B组和C组比较B组予以肠内营养后下降较C组明显,差异有统计学意义(P<0.05)。B组和C组感染率、病死率、并发症发生率、住院时间、住院费用较A组明显低(P<0.05),B组与C组比较感染率、病死率、并发症发生率B组明显低于C组(P<0.05)。结论:早期肠内营养可改善急性重症胰腺炎早期炎症反应,从而减低感染率、病死率、并发症发生率。在患者循环稳定条件下,越早予以肠内营养对患者的预后越有...     

晶胶联合大黄在早期治疗重症急性胰腺炎中的临床意义

目的:研究晶胶联合大黄在早期治疗重症急性胰腺炎中的临床意义.方法:选取2011年1月至2013年1月已被收治的符合标准的病例共174例重症急性胰腺炎患者随机分为晶胶联合组(A组)和晶胶联合大黄组(B组)两组,每组87例,观察不同治疗方案对液体负平衡出现时间(D1),肠道功能恢复时间,病死率及多器官功能障碍综合征(MODS)发生率,红细胞压积(HCT),液体滞留总量,血乳酸,中心静脉血氧饱和度(ScvO2),胃黏膜pH值(pHi)等指标的影响.结果:治疗后B组各项指标的改善均优于A组(P＜0.05).B组治疗后的液体负平衡出现时间(70±16.8)h,液体滞留总量(425.5± 90.5) mL,肠道功能恢复时间(39±9.5)h,MODS发生率为18.4％,病死率为4.6％,HCT(30.2± 9.5)％,ScvO2为(87.4±12.7)％,pHi为(7.9±1.1),血乳酸为(1.4±0.8)mmol/L(所有P＜0.05).结论:在早期治疗重症急性胰腺炎时应用晶胶联合大黄组可缩短负平衡出现时间,加速循环血容量恢复,增加组织血液灌注和供氧,促进肠道功能恢复,维护重要脏器功能,缩短液体复苏的时间,改善该病的预后,有显著的临床意义.     

早期肠内营养在重症急性胰腺炎中的应用

目的:探讨早期肠内营养在重症急性胰腺炎治疗中的应用价值。方法:将重症急性胰腺炎患者30例分为实验组和对照组,对照组予以常规治疗,实验组在常规治疗的基础上通过鼻空肠管予以早期肠内营养,记录患者WBC、CRP、血淀粉酶、尿淀粉酶恢复时间、白蛋白变化情况、感染率、病死率、并发症发生率、住院时间、住院费用等。结果:实验组WBC、CRP、血淀粉酶、尿淀粉酶恢复时间较对照组明显低,有显著性差异(P<0.05);实验组血清白蛋白升高较对照组明显高,有显著性差异(P<0.05);实验组感染率、病死率、并发症发生率较对照组明显低,但无显著差别(P>0.05);实验组住院时间、住院费用较对照组低,有显著性差异(P<0.05)。结论:早期肠内营养可以改善急性重症胰腺炎营养状况,缩短病程、减低感染率、病死率、并发症发生率、住院时间及住院费用。     

益生菌与重症急性胰腺炎

重症急性胰腺炎（SAP）病情危重,病死率高,发病机制复杂,至今未完全阐明。在病程的第1周,由于全身炎症反应综合征引起多器官功能障碍,在病程的第1—3周,由于感染和菌血症引起第2个死亡高峰,占病死率的80％。目前认为细胞因子的过度生成和肠屏障功能损伤导致肠内细菌移位,是发生胰腺坏死感染的主要原因。针对此类感染的早期抗生素预防治疗一直存在争议,而且大量长期的抗生素应用易导致细菌的抗药性及真菌的过度生长。     

连续肾脏替代疗法治疗重症急性胰腺炎时机的探讨

目的:探讨连续肾脏替代疗法(CRRT)治疗重症急性胰腺炎的最佳时机。方法:选取我院收治的30例重症急性胰腺炎(SAP)患者为研究对象,按发病后行CRRT的时间分将患者随机为A、B两组,A组发病后72小时内治疗,B组发病后72小时后治疗,分析和比较两组治疗后的临床转归及生命体征变化、APACHEⅡ评分变化急性生理与慢性健康状况、住院费用、平均住院时间。结果:经CRRT治疗后,A组死亡率(14.3%)低于B组(43.7%),差异有统计学意义(P0.05);A、B两组治疗后体温、心率、呼吸、平均动脉压平稳,A组优于B组,差异有统计学意义(P0.05);A组的平均住院时间(15.7±8.9)d、住院费用(107000±65000)万元均明显优于B组,差异有统计学意义(P0.05);两组患者治疗后APACHEⅡ评分均明显优于治疗前,治疗后A组APACHEⅡ评分明显优于B组,差异显著有统计学意义(P0.05)。结论:早期行CRRT能明显改善重症急性胰腺炎患者的疗效和预后,最佳治疗时机可能为发病后72小时内。     

Role of CARD9 in inflammatory signal pathway of peritoneal macrophages in severe acute pancreatitis

Previous studies revealed that caspase recruitment domain protein 9 (CARD9) was involved in severe acute pancreatitis (SAP) inflammation and that interfering with its expression in vivo could inhibit inflammation. However, the specific mechanism is unknown. This study aimed to discover the related signal pathways of CARD9 in macrophages. SiRNA interference technology was used in vivo and in vitro to detect CARD9‐related signal pathways in peritoneal macrophages. Furthermore, Toll‐like receptor 4 (TLR4) and membrane‐associated C‐type lectin‐1 (Dectin‐1) pathways in macrophages were activated specially to looking for the upstream signal path of CARD9. Results showed up‐regulation of CARD9 expression in peritoneal macrophages of SAP rats (P < .05). CARD9 siRNA alleviated inflammatory cytokines, and inhibited the phosphorylation of NF‐κB and p38MAPK in peritoneal macrophages in vivo or in vitro. Meanwhile, CARD9 siRNA reduced the concentration of CARD9 and Bcl10 in peritoneal macrophages, and TLR4 and Dectin‐1 took part in CARD9 signal pathways in macrophages. In conclusion, there is an inflammation signal pathway comprised of TLR4/Dectin‐1‐CARD9‐NF‐κB/p38MAPK activated in macrophages in SAP. Blockade of CARD9 expression in macrophages can effectively alleviate SAP inflammation.     

TLR and MBL gene polymorphisms in severe acute pancreatitis

BACKGROUND AND OBJECTIVE: Mannose-binding lectin (MBL) and toll-like receptor (TLR)-4 gene polymorphisms have been implicated in inflammatory episodes in a number of studies. In view of the inflammatory nature of acute pancreatitis, we aimed to determine the predictive value of two point mutations in the promoter region at position -550 (H/L variants) and -221 (X/Y variants) of the MBL2 gene, and the Asp299Gly and 119C>A polymorphisms of the TLR4 gene on the occurrence of severe acute pancreatitis (SAP). METHODS: The study included 132 patients with SAP, 106 with mild acute pancreatitis (MAP), and 121 healthy volunteers. Genotypes were determined using restriction fragment length polymorphism analysis of PCR products and by allele-specific PCR. RESULTS: No significant difference in genotype frequency was noted between the patients with acute pancreatitis and controls for any of the gene loci studied. The distributions of the HY/HY, HY/LY, LY/LY, and LY/LX genotypes of MBL2 gene promoter and 119C>A genotype of the TLR4 gene were similar in patients with mild or severe acute pancreatitis. HY/LX genotype frequency was significantly higher in patients with SAP compared with MAP (26% vs 14%; p = 0.028). CONCLUSION: Results indicate that the MBL2 HY/LX genotype plays an important role in the determination of disease severity to acute pancreatitis.     

真菌性腹膜透析相关性腹膜炎的诊治进展

真菌性腹膜炎是影响腹膜透析的主要因素之一,与细菌性腹膜炎相比,其病亡率更高。尽管随着技术的改进和管理的提升,真菌性腹膜炎的发病率明显降低,全球发病率为2.0%~23.8%,但对于患者个人来说腹膜炎仍是影响其生存及预后的主要因素。国际腹膜透析协会建议一旦确诊为真菌性腹膜炎,需要尽早拔管并继续进行抗感染治疗至少2周,最终才能继续腹膜透析。早期预防和及时规范诊治是维持长期腹膜透析成功的关键,本研究结合近年来国内外的真菌性腹膜炎诊治的研究进展作一综述。     

Arteriovenous hemofiltration as an adjuvant therapy in peritoneal dialysis and hemodialysis in a patient with terminal renal failure]

In the uraemic patient regularly treated with peritoneal dialyses occurring peritonitis caused a decrease of ultrafiltration and transfer abilities of the peritoneum. Other symptoms dangerous for life also appeared: uraemic pericarditis and significant overhydration. Peritoneal dialyses lost its effectiveness. Therefore they were supplemented by arterio-venous haemofiltration. Haemofiltration was also conducted at the beginning of haemodialysis treatment, which was initially unregular. Application of haemofiltration enabled the patient to survive during the time of waiting for regular haemodialyses. It may be useful to consider such a treatment, when the adequacy of proper renal substitutive management of uraemia by other methods is impossible to obtain.     

Central role of neutrophil in the pathogenesis of severe acute pancreatitis

Severe acute pancreatitis (SAP) is an acute abdominal disease with the strong systemic inflammatory response, and rapidly progresses from a local pancreatic damage into multiple organ dysfunction. For many decades, the contributions of neutrophils to the pathology of SAP were traditionally thought to be the chemokine and cytokine cascades that accompany inflammation. In this review, we focus mainly on those recently recognized aspects of neutrophils in SAP processes. First, emerging evidence suggests that therapeutic interventions targeting neutrophils significantly lower tissue damage and protect against the occurrence of pancreatitis. Second, trypsin activation promotes the initial neutrophils recruitment into local pancreas, and subsequently neutrophils infiltration in turn triggers trypsin production. Finally, neutrophils have the unique ability to release neutrophil extracellular traps even in the absence of pathogens.