急性胰腺炎鸿合并腹腔间隔综合症英语.pptVIP

Jinling Hospital Jinling Hospital Case Report Admission A 56-year-old male was admitted to SICU of Research Institute of General Surgery, Jinling Hospital on 20th Oct 2003 He sufferd from epigastric pain for two days, dyspnea and decreased urine output for one day after a fat rich diet PE on Admission T 38℃, HR 140bpm, RR 30/min, BP 82/58mmHg Oxygen saturation 92% Acute face with shortness of breath, in agitated state, far distended abdomen with high tension, signs of diffusive peritonitis, weak bowel sounds Bloody ascites was drawn out by diagnostic puncture Urine output decreased further and anuria developed Lab Examination on Ad Hb 18g/dl WBC 11300/mm3( N0.88 L0.09) Platelet 95000/mm3 Amy(serum) 1270U/L Amy(urine)14819 Lipase 10003U/L Ca 1.9mmol/L BUN 49mg/dl SCr 4.0mg/dl Arterial blood gas analysis：pH 7.26, PaO2 55mmHg, PaCO2 28 mmHg, BE –14.5mmol/L CT: Diffusive necrosis of pancreas, massive ascites, left pleural effusion Diagnosis Severe acute pancreatitis ARDS ARF Shock Abdominal compartment syndrome Treatment Intubation, tracheostomy,mechanical ventilation Fluid resuscitation and anti-shock therapy Intraabdominal irrigation by laparoscopy, continous draining by persistent negative pressure Continuous venovenous high volume hemofiltration Anti-acid therapy and Inhibition of pancreatic secretion prophylactic antibiotic theray Advancement of the Illness and Outcome of the Patient 3rd hospital day, developed “Abdominal Compartment Syndrome ”, and received the 2nd emergent operation as abdominal opening and gastrointestinal fistulization to relieve the abdominal high pressure Advancement of the Illness and Outcome of the Patient 14th day, intestinal function partially recovered and TPN was gradually switched to enteral nutrition 28th day, CVVH discontinued, urine output increased to more than 2000ml/d . 36th day, mechanical ventilation ceased serum creatinine returned to normal range on 48th day 39th day, and 57th day, received two ti