区域动脉灌注治疗重症急性胰腺炎探究进展.docVIP

区域动脉灌注治疗重症急性胰腺炎探究进展【摘要】重症急性胰腺炎仍是一种致死性的疾病，常常合并多器官功能衰竭及胰腺感染坏死，死亡率高。血管内凝血增加以及由于血管痉挛致胰腺缺血容易诱发胰腺坏死变化，胰腺缺血以及血栓形成在重症急性胰腺炎中起了重要作用。由于药代动力学特征和微循环障碍使得药物很难通过静脉注射到达胰腺组织。将一导管置入供应胰腺炎症部位血流的血管内，可大大提高药物浓度。区域动脉灌注这项新治疗技术的研究已经展开，并且已经证实了它在治疗重症急性胰腺炎上的治疗效果，现对其研究进展做一叙述。 【关键词】重症急性胰腺炎 区域动脉灌注 进展 中图分类号：R576.1文献标识码：B文章编号：1005-0515（2011）2-302-04 Progress in local arterial infusion treatment of severe acute pancreatitis Xuan Donghui YangLin （Department of General abdominal surgery，Affiliated First Hospital of university of South China，hengyang 421001） 【Abstract】Severe acute pancreatitis is still a fatal disease. It is often associated with multiple organ failure and infected pancreatic necrosis resulting in a high mortality rate. An increase in intravascular coagulation and pancreatic ischemia associated with vasospasm may easily induce necrotic changes in the pancreas. pancreatic ischemia and the formation of a microthrombosis play an important role in severe acute pancreatitis.Drugs cannot easily reach the pancreas when administered intravenously because of its pharmacokinetic characteristics and impaired microcirculation. Administration through a catheter placed in one of the arteries which supplies the inflamed area of the pancreas, dramatically increases the concentration of the protease inhibitors in the pancreas. Studies of local arterial infusion have been conducted and have demonstrated the therapeutic efficacy of the new treatment in severe acute pancreatitis. Now make a statement on its research progress. 【Key words】Severe acute pancreatitis; local arterial infusion; progress 重症急性胰腺炎(severe acute pancreatitis, SAP)发病急骤，病情凶险、并发症多，病死率高，是严重的急腹症之一。过去主张早期手术治疗，并发症及病死率并未降低。近年来，随着人们对重症急性胰腺炎病理生理过程研究的不断深入，个体化综合治疗日益受到重视，这种情况下选择有效的药物，采用合理的给药途径，增强疗效，就显得很有必要。区域动脉灌注（local arterial infusion LAI）疗法正是在这种要求下，伴随着介入放射学等学科的发展而产生发展起来的。 1 LAI治疗SAP的原理 区域动脉灌注出现在60年代，开始主要是针对不能切除的晚期肿瘤。根据研究，药物对肿瘤细胞的杀伤作用是“浓度依赖性”，治疗关键是通过动脉灌注在病灶周围形成局部高浓度使药物得以发挥最大“正作用”，降低对无关脏器损伤，LAI治疗SAP也出于同样的机制[1]。 2 L