培训课件-第十九课急性胰腺炎.ppt

局部并发症的治疗 假性囊肿 无菌性坏死 脓肿 胆源性胰腺炎 解除梗阻 胆道取石 乳头切开术 胆囊切除术 抗感染 全身并发症的治疗 止痛 高血糖及酮症 低钙血症 低镁血症 低氧血症 吸氧：面罩或鼻管 辅助呼吸 ARDS：给予PEEP(呼吸末正压通气)。　 心力衰竭：适当调整补液量和速度。 肾前性氮质血症：加强补液防治肾衰竭，必要时透析(通常为腹膜透析) 全身并发症的治疗 手术治疗 感染性胰腺坏死 胰腺脓肿 胰腺假性囊肿：6cm 诊断未明确，不排除腹腔脏器穿孔或肠坏死者行开腹探查术 预后 取决于病变程度和并发症 轻型预后良好，多于1周内恢复，不留后遗症 重症预后差 最初常死于休克、肾衰竭、呼吸衰竭、偶尔心力衰竭或猝死 1W以后死于感染或假性囊肿 Tests for Chronic Pancreatitis 思考题 急性胰腺炎腹痛的特点。 急性胰腺炎应与哪些疾病进行鉴别？ 急性胰腺炎的局部和全身并发症。 急性胰腺炎的治疗原则。 谢 谢！ * Oblique transverse cross-section of the upper abdomen viewed from below. The section passes through the long axis of the pancreas at approximately the level indicated in the inset. The disposition and relations of structures shown approximate those seen on oblique transverse ultrasonic scanning. * Acinar cells surrounding a terminal branch of a pancreatic duct. Note the abundant rough endoplasmic reticulum and the zymogen granules concentrated at the apexes of the cells. * Activation of the pancreatic proteases in the duodenal lumen * Initiation of acute pancreatitis. Various forms of insults initiate a cascade of events that result in acute pancreatitis. The pancreatic acinar cell responds to a variety of insults with activation of zymogens, inhibition of secretion, and release of proinflammatory substances. Inflammatory cells are activated. Expression of adhesion molecules promotes retention of inflammatory cells within the pancreas. Pancreatic blood flow may decrease because of capillary leaks, compression by edema, and vascular damage and occlusion. Toxic factors produced by pancreatic cells and inflammatory cells cause pancreatic cell death. Generalized activation of inflammatory cells may lead to the systemic inflammatory response syndrome and multisystem organ failure. * a Severity is graded on the basis of more severe local or systemic complication (e.g., sterile pancreatic necrosis without organ failure has to be graded as “ moderate ” ; sterile pancreatic necrosis with persistent organ failure has to be graded as “ severe ” ). * The C