胰腺疾病pancreatitis双语幻灯.pptVIP

The treatment needs to be tailored to each individual patient, considering the techniques available in each Institution Treatment of Acute Pancreatitis A Critical Appraisal of the Clinical Trials in Acute Pancreatitis Colipase Elastase Chymotrypsin Phospholipase A2 Xanthynedehydrogenase Kallycrein C3a C5a Plasminogen XIIa Factor Systemic circulation Alfa2 + Trypsin Alfa2-M RES Liver Spleen Bone marrow Nodes Clearance Procolipase Proelastase Chymotrypsinogen Prophospholipase A2 Xanthynedehydrogenase Prokallycrein C3 C5 Plasminogen XII Factor Kininogens Kinins Trypsinogen Trypsin Trypsin PSTI + Trypsin PSTI Alfa1-AT + Trypsin Alfa1-AT Mesotrypsin Enzyme Y Several steps may have to be blocked at the same time and this may be achieved by using combinations of several drugs at the same time or by the multiple actions of a single drug Norman J. Am J Surg 1998; 175:76-83. (modified) [2] Acute Pancreatitis Complications: Vascular leakage Hypovolemia Shock ARDS Acute renal tubular necrosis IL-1 TNF N.O. PAF IL-6 IL-8 Other leucocyte products Oxygen radicals Elastase IFN-α,γ IL-10 IL-2 急性胰腺炎治疗模式的转变 1930’s以前 1930－60’s 1990以后 1960－80’s 早期手术 全面保守 扩大手术 内外科相结合的综合治疗 当今急性胰腺炎治疗指南 急性胰腺炎 胰腺坏死 脓毒血症 无毒血症状 病情恶化 治疗好转 感染性坏死 无菌性坏死 保守治疗 手术治疗 CE-CT FNA CT上出现气泡 Current Treatment Strategy in acute pancreatitis Intensive Supportive Care Symptomatic and supportive care Suppression of the presumed cause and Reduce Inflammation Assess and Treat Complications by rational surgical intervention- Abscess, bleeding and obstruction no clinical improvement within 4 weeks of ICU. Symptomatic and supportive care Fluid resuscitation Monitor accurate intake/output and electrolyte balance of the patient. Crystalloids are used, but other infusions, such as packed red blood cells (PRBCs), are occasionally administered, particularly in the case of hemorrhagic pancreatitis. Central lines and Swan-Ganz catheters are used in patients with severe fluid loss and very low blood pressure. pain reli