急性胰腺炎的临床处理美国胃肠病学,20135.ppt

LAST In general, patients undergoing volume resuscitation should have the head of the bed elevated, undergo continuous pulse oximetry, and receive supplemental oxygen. 患者进行液体复苏时，需抬高床头，持续的血氧饱和度监测及吸氧。 Lactated Ringer’s solution reduces the incidence of SIRS by 80% compared with saline. Nevertheless, LR’s solution is a reasonable choice for initial resuscitation, based on its positive effects on acid-base homeostasis, compared with large-volume saline resuscitation. Because lactated Ringer’s solution contains calcium, it should not be administered in quantity to patients with hypercalcemia. 与用生理盐水复苏相比，乳酸林格氏液能减少80%的SIRS发生，乳酸林格氏液对维持酸碱平衡有积极的影响，更加适用于早期的液体复苏， 高钙血症患者慎用。 Volume expansion with colloid has not been shown to be more effective than with crystalloids in critically ill patients. 对于危重病人，使用胶体液扩容的益处并不多于使用晶体液。 NO.2 Indications for Intensive Care 重症监护的适应症 Respiratory failure is the most common form of organ dysfunction. Patients with signs of respiratory failure or hypotension that fail to respond to initial resuscitation should be considered for direct admission to an intensive care unit（ICU）. 呼吸衰竭是最常见的器官功能障碍，病人因为没有进行早期的液体复苏，而出现了呼吸衰竭或低血压的迹象，可以直接送至 ICU。 Patients with multiorgan dysfunction are at the greatest risk for death and should be managed in a critical care setting with a multidisciplinary care team. 存在多器官功能障碍是最重要的死亡因素，必须成立多由学科治疗团队组成的特别治疗组进行临床管理及诊治。 In addition, patients with persistent SIRS, increased levels of BUN or creatinine, increased hematocrit, or underlying cardiac or pulmonary illness should strongly be considered for management in a monitored setting. 另外，对有持续性SIRS、BUN水平升高、HCT升高或潜在的心肺疾病的病人，需在有监控设置下进行管理及治疗。 NO.3 Indications for Transfer 转院指征 Data from the Nationwide Inpatient Sample indicate that patients with acute pancreatitis treated at high-volume centers (≥118 admissions/y) have a 25% lower relative risk of death than patients treated at low-volume centers. Thus, patie