134例重症急性胰腺炎回顾性分析
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摘要
目的研究重症急性胰腺炎(Severe Acute Pancreatitis,SAP)的临床特征及治疗措施。
方法回顾性分析我院1996～2006年134例SAP的临床资料,包括患者年龄,性别,病因,住院时间,临床症状,并发症,治疗措施和疗效。分析重症急性胰腺炎中的特殊类型—暴发性急性胰腺炎(Fulminant AcutePancreatitis,FAP)的临床特征,探讨治疗措施。
结果SAP发生的年龄20～85岁,其中30～60岁93例,占69.4%,平均年龄45.12±15.76岁,平均住院日23±22天;主要病因为胆道系统疾病,占32%,不明原因的SAP发生率高(25%);胸,腹水的发生率分别为44.0%、69.4%;本组SAP患者死亡率为14.2%;患者血清淀粉酶升高与否与病死率无关;FAP占本组SAP的20.9%;FAP组患者的并发症发生率和死亡率较SAP组患者明显升高;低氧血症与急性肾功能衰竭的发生率在FAP患者中较其他脏器衰竭显著升高。
结论SAP多发生于30～60岁;胸,腹水的发生率在重症急性胰腺炎患者中高,胸水与并发症发生率及病死率无关;腹水与并发症发生率相关,与病死率无关;血淀粉酶升高与否与预后无关;SAP个体化治疗可取得良好效果;FAP是SAP的特殊类型,早期出现器官衰竭,死亡率高,临床上应予高度重视,尤其是低氧血症及急性肾功衰竭早期发生率高,应予早期识别,不失时机的救治FAP。
Objective To investigate a consecutive series of patients with severe acute pancreatitis(SAP),to identify clinical characteristics and therapeutic effects.
Methods Clinical data of 134 cases of SAP admitted to the first affiliated hospital of Guangxi Medical University from 1996 to 2006 were retrospectively reviewed.The data included the patients'age,gender,etiology,length of hospitalization,clinical symptom,complication,procedure of treatment,curative result and analyzed a special type of fulminant acute pancreatitis(FAP).
Results The mean age of the patients was 45.12±15.76 years;the mean length of hospitalization was 23±22 days;the main etiological factors are biliary system disease(32%),the incidence of unknown origin was high(25%).The incidence of ascites and pleural effusion were very high in SAP patients.The mortality rate was 14.2%;the incidence of complication and mortality of FAP were higher than SAP.
Conclusions Patients of SAP commonly occurred in 30～60 years.The incidence of unknown origin was high(25%).The level of serum amylase was irrelevant with the severity of SAP.The incidence of ascites and pleural effusion were very high in SAP patients;and the incidence of complication were significant higher in patients with ascites.In the earlier stage of SAP,the treatment should be observed carefully and combined therapy of internal medicine as soon as the indications of operation were found.FAP is a special type of SAP,with its high mortality,especially the high incidence of hypoxemia and acute renal failure,the effected therapeutic method should be attached great importance to the patient.
方法回顾性分析我院1996～2006年134例SAP的临床资料,包括患者年龄,性别,病因,住院时间,临床症状,并发症,治疗措施和疗效。分析重症急性胰腺炎中的特殊类型—暴发性急性胰腺炎(Fulminant AcutePancreatitis,FAP)的临床特征,探讨治疗措施。
结果SAP发生的年龄20～85岁,其中30～60岁93例,占69.4%,平均年龄45.12±15.76岁,平均住院日23±22天;主要病因为胆道系统疾病,占32%,不明原因的SAP发生率高(25%);胸,腹水的发生率分别为44.0%、69.4%;本组SAP患者死亡率为14.2%;患者血清淀粉酶升高与否与病死率无关;FAP占本组SAP的20.9%;FAP组患者的并发症发生率和死亡率较SAP组患者明显升高;低氧血症与急性肾功能衰竭的发生率在FAP患者中较其他脏器衰竭显著升高。
结论SAP多发生于30～60岁;胸,腹水的发生率在重症急性胰腺炎患者中高,胸水与并发症发生率及病死率无关;腹水与并发症发生率相关,与病死率无关;血淀粉酶升高与否与预后无关;SAP个体化治疗可取得良好效果;FAP是SAP的特殊类型,早期出现器官衰竭,死亡率高,临床上应予高度重视,尤其是低氧血症及急性肾功衰竭早期发生率高,应予早期识别,不失时机的救治FAP。
Objective To investigate a consecutive series of patients with severe acute pancreatitis(SAP),to identify clinical characteristics and therapeutic effects.
Methods Clinical data of 134 cases of SAP admitted to the first affiliated hospital of Guangxi Medical University from 1996 to 2006 were retrospectively reviewed.The data included the patients'age,gender,etiology,length of hospitalization,clinical symptom,complication,procedure of treatment,curative result and analyzed a special type of fulminant acute pancreatitis(FAP).
Results The mean age of the patients was 45.12±15.76 years;the mean length of hospitalization was 23±22 days;the main etiological factors are biliary system disease(32%),the incidence of unknown origin was high(25%).The incidence of ascites and pleural effusion were very high in SAP patients.The mortality rate was 14.2%;the incidence of complication and mortality of FAP were higher than SAP.
Conclusions Patients of SAP commonly occurred in 30～60 years.The incidence of unknown origin was high(25%).The level of serum amylase was irrelevant with the severity of SAP.The incidence of ascites and pleural effusion were very high in SAP patients;and the incidence of complication were significant higher in patients with ascites.In the earlier stage of SAP,the treatment should be observed carefully and combined therapy of internal medicine as soon as the indications of operation were found.FAP is a special type of SAP,with its high mortality,especially the high incidence of hypoxemia and acute renal failure,the effected therapeutic method should be attached great importance to the patient.
引文
1.中华医学会消化病学分会胰腺疾病学组.急性胰腺炎诊疗指南.中华消化杂志,2004,24:190-192.
2.黄平,沈云志.重症急性胰腺炎的诊治进展.江苏医药,2003,29:536-537.
3.Imrie CW,Ferguson JC.Coxsackie and mums virus infection in prospective study of acute pancreatitis.Gut 1977,18:53-56.
4.褚琦,龚自华.实验性胰腺炎研究进展.见:上海科学技术文献出版社,上海,2001,89,105.
5.Ros E,Navarro S,Bru C,et al.Occult Microlithiasis in"idiopathic"acute pancreatitis:prevention of elapses by cholecystectomy or ursodeoxycholic acid therapy.Gastroenterology,1991,101:1701-1709.
6.Lee SP,Nicholls JF,Park HZ.Biliary sludge as a cause of acute pancreatitis.N Engl J Med,1992,326(9):589-593.
7.Bernard JP,Sahel J,Giovannini M,et al.Pancreas divisum is a probable cause of acute pancreatitis:a report of 137 cases.Pancreas 1990,5:248-254.
8.Nagar AB,Gorelick FS.Acute pancreatitis Current Opinion in Gastroenterology.Gastroenterology,2004,20:439-443.
9.Kamisawa Y.Clinical significance of the minor duodenal papilla and accessory pancreatic duct.J Gastroenterol,2004,39:605-615.
10.Kamisawa T,Amemiya K,Egawa N,et al.Pancreatitis associated with congenital abnormalities of the pancreatico-biliary system.Hepatobiliary Pancreat Surg,2005,12:99-102.
11.杨茂悟,李继强,范竹萍,等.重症胰腺炎并发浆膜腔积液58例临床分析.中华消化杂志,1998,18(5):278-280.
12.陈若川,赵海剑,方向,等.胰腺相关性腹水诱导大鼠肺损伤的实验研究.肝胆胰外科杂志.2005,17(4):282-284.
13.Slavin J,Ghaneh P,Sutton R,et al.Management of necrotizing pancreattis.Word Gastroenterol,2001,7(4):476-481.
14.程宝泉,钟宁.重症急性胰腺炎腹水对正常肾细胞影响.中国现代普通外科进展,2005,8(3):212-215.
15.刘殿冈,孙家邦,李非,等.胰腺炎相关性腹水对大鼠胃肠动力的影响.北京医学,2005,27(9):546-548.
16.黄鹤光,冷希圣.重症急性胰腺炎患者血和腹水一氧化氮的动态变化.中华实验外科杂志,2002,19(3):241-242.
17.Maringhim A,Ciambra M,Patti P,et al.Aseites,pleural and perieardial efusions in acute panereatitis,Dig Dis Sci,1996,41:848-852.
18.刘春萍,陆慰萱.消化系统疾病的肺部表现.临床内科杂志,2003,20(7):340-342.
19.李波,刘续宝.重症急性胰腺炎并发急性浆膜腔积液的诊断与处理.见:张肇达,严律南,刘续宝主编.急性胰腺炎.第1版.北京:人民卫生出版社,2004,223-224.
20.Kylanpaa Back ML,Kemppainen E,Puolakkainen P,et al.Based Laboratory Methods and Carboxypeptidase Activation Peptide in Acute Pancreatitis.J Pancreas,2002,3(2):34-48.
21.孙家邦,王亚军.重症急性胰腺炎的早期处理.首都医科大学学报,2007,28(1):42-46.
22.Piri M,Alhan E,Kucuktulu U,et al.The effects of somatostatin on the microperfusion of the pancreas during acute necrotizig pancreatitis in rats.Hepatogastroenterology,May-Jun:49(45):833-837.
23.Andoh A,Hata K,Shimada M,et al.Inhibitory effects of somatostation on tumor necrosis factor-alpha-induced interleukin-6 secretion in human pancreatic periacinar myofibroblasts.Int J Mol Med,2002,Jul;10(1):89-93.
24.王国品.急性胰腺炎现代治疗中的一些观点.中国急救医学,2001,21:434-435.
25.Ratschko M,Fenner T,Lankisch PG.The role of antibiotic prophylaxis in the treatment of acute pancreatitis.Gastroenterol C lin North Am,1999,28:641-659,ix-x.
26.Moody FG,Haley-Russell D,et al.Intestinal transit and bacterial translocation in obstructive pancreatitis Dig DIS Sci 1995,40;1799-1804
27.Garg PK,Khanna S,Bohidar NP,Muncy DM.Incidence,spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis.J Gastroenterol Hepatol,2001,sep;16(9):1055-1059.
28.王兴鹏.重视肠道衰竭在重症急性胰腺炎发病重的作用.中华消化杂志,2002,22(1):5-6.
29.陈晓理,冯凯祥.肠道动力学改变在急性胰腺炎的病程及治疗中的意义.中国普外基础与临床,1999,6(6):325-327.
30.严律南.重症急性胰腺炎手术指征和时机的选择.中华实用外科学杂志,1999:19(9):529.
31.中华医学会消化病分会急性胰腺炎诊治指南.胰腺病学,2003,3(增刊):S89-S92.
32.张圣道.重症急性胰腺炎诊治指南增补修订的说明.胃肠病学,2006,6(增刊):S5-S6.
33.UK Working party on Acute Pancreatitis.UK guidelines for the management of acute pancreatitis,GUT 2005,54(SupplⅢ):ⅲ1-ⅲ9.
34.Raraty MG,Connor S,Criddle DN,et al.Acute pancreatitis and organ failure pathophysiology,natural history,and management strategies.Curr Gastoenterol Rep,2004,699-103.
35.Sultan S,Baillie J.What the predictors of post-EKCP pancreatitis,and how useful are they.Jop,2002,3(6):188.
36.Balteskard L,Unneberg K,Mjaaland M,et al.Growth hormone and ingulinlike growth factor-1 promote intestinal uptake and hepatic release of glutamine in sepsis.Ann Surg,1998,228(1):131-139.
37.Zhang QH,Cai D.Protect role of multiple organ dysfunction syndrome on acute necrotizing pancreatitis with somatostatin and growth hormone.Int J pancreatol,1998,23:288-289.
38.Bosscharm K,Halstaett PE,Hennipinan A,et al.Fulminant acute pancreatitis and infected necresis:results of management of abdoment and "Planned"reparations.J Am Coil Stag,1998,(187):255-262.
39.张圣道,汤耀卿,李宏为,等.特重型急性胰腺炎救治措施探讨(附一例报告).外科理论与实践,2000,5:97-99.
40.彭淑牖,牟一平,蔡秀军.重视暴发性急性胰腺炎的诊断和治疗.外科理论与实践,2001,6:68-70.
41.Shields CJ,Winter DC,Redmond HP.Systemic complications of acute pancreatitis,Curr Opin Crit Care.2002,8:158-163.
42.孙家邦,朱斌.暴发性胰腺炎诊治关键探索.中国实用外科杂志,2003,23(1):53-55.
43.Windor JA,Hammodat HH.Metabolic management of severe acute pancreatitis.World J Surg,2000,24:46-48.
44.Mark A,Malangoni,Adam S,et al.Pancreatitis.Am J Surg,2005,189(3):273-277.
1.Soumitra RE,Lynn JH,Philip SB.Severity scoring for prognostication in patients with severe acute pancreatitis:comparative analysis of the Ranson score and the APACHE Ⅱ score.Archives of Surgery,2002,137(6):730-737.
2.李明贤,贾林.重症急性胰腺炎的临床发病学特征及预后分析.中国综合临床,2006,22(10):902-904.
3.中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南.中华消化杂志,2004,24(3):190-192.
4.张圣道,张臣烈,汤耀卿,等.急性坏死性胰腺炎全病程演变及治疗对策.中华外科杂志,1997,35(3):156-157.
5.Kiriyama S,Kumada T,Tanikawa M.Recent advances in biochemical diagnosis and assessment of severity in acute pancreatitis.Nippon Rinsho,2004,62(11):2035-2039.
6.张肇达,严律南主编.急性胰腺炎.第1版.北京:人民卫生出版社,2004,59.
7.Rau B,Schilling MK,Beggr HG,et al.Laboratory markers'of severe acute pancreatitis.Dig Dis,2004,22(3):247-257.
8.曲永柏,董琦,隋武,等.血清IL-6、TNF-α测定对急性重症胰腺炎预后评价的意义.宁夏医学杂志,2005,27(6):383-385.
9.刘香萍,汪小娟,胡钶,等.重症胰腺炎血清sICAM-1、IL-6、YNF-α含量的变化和意义.临床医学研究,2006,23(1):40-42.
10.高勇,周波,叶世会.急性重症胰腺炎患者血清肿瘤坏死因子α、白细胞介素10水平变化及意义.中国临床医学,2006,13(5):761-762.
11.张晓云,汪东剑,余维涛.血清IL-6、IL-8、TNF-α在重症急性胰腺炎早期诊断中的临床意义.胰腺病学,2004,4(1):26-28.
12.Bbatia M,Shokuhi S,Shokuhi S.Inflammatory mediators in acute pancreatitis.J Path,2000,190 P:117-125.
13.Dembinski A,Warzecha Z,Ceranowicz P,et al.Pancreatic damage and regeneration in the course of ischemia-reperfusion induced pancreatitis in rats.J Physiol Pharmacol,2001,52(2):221-235.
14.Norman J,Fink G,Franz M,et al.Active interleukin-1 receptor required for maximal progression of acute pancreatitis.Ann Surg,1996,223(2):163-169.
15.Jiang CF,Shiau YC,Ng KW,et al.Serum interleukin-6 tumor necrosis factor alpha and C-reactive protein in early prediction of severity of acute pancreatitis.J Chin Med Assoc,2004,67(9):442-446.
16.Triester SL,Kowdley KV.Prognostic factors in acute pancreatitis.J Clin Gastroenterol,2002,34:167-176.
17.Nikou GC,Giamarellos-bourboulis EJ,Grecka P,et al.Effect of octreotide administration on serum interleukin-6(IL-6)levels of patients with acute edematous pancreatitis.Hepatogastroenterology,2004,51:599-602.
18.Gurleyik G,Cirpici OZ,Aktekin A,et al.The value of Ranson and APACHE-Ⅱ scoring systems,and serum levels of interleukin-6 and C-reactive protein in the early diagnosis of the severity of acute pancreatitis.Ulus Travma Derg,2004,10(2):83-88.
19.钟宏,陈喜志,刘国伟.重症急性胰腺炎患者血清TNF-α和IL-6水平的动态变化及临床意义.中国医药,2006,1(8):472-474.
20.Pooran N,Indaram A,Singh P,et al.Cytokines(IL-6,IL-8,TNF):early and reliable predictors of severe acute pancreatitis.ClinGastroeter,2003,37(3):263-266.
21.Naskalski JW,Kusnierz-Cabala B,Panek J,et al.Poly-C specific ribonuclease activity correlates with increased concentrations of IL-6,IL-8 and sTNFR55/sTNFR75 in plasma of patients with acute pancreatitis.Physiol Pharmacol,2003,54(3):439-448.
22.Han XC,Zhang YC,Wang Y,et al.Clinical evaluation of serum interleukin 10 in patients with acute pancreatitis.Hepatobiliary Pancereat Dis Int,2003,2(1):135-138.
23.Suzuki K,Nakaji S,Kurakake S,et al.Exhaustive exercise and type-1/type-2 cytokine balance with special focus on interleukin-12p40/p70.Exerc Immunol Rev,2003,9(1):48-57.
24.Uehara S,Gothoh K,Handa H,et al.Immune function in patients with acute pancreatitis.Gastroenterol Hepatol,2003,18(4):363-370.
25.贺丽,陈少夫,曹晓辉,等.急性胰腺炎患者IL-15、IL-18、STNF-1R的变化意义.世界华人消化杂志,2003,11(1):57-60.
26.Victorino GP,Newton CR,Curran B.Modulation of mircrovascular hydraulic permeability by platelet-activating factor.Trauma,2004,56(2):379-384.
27.Boccellino M,Biancone L,Cantaluppi V,et al.Effect of platelet-activating factor receptor expression on CHO cell motility.Cell Physiol,2000,83:254-264.
28.赵志伶,夏时海,陈虹.重症急性胰腺炎胰腺组织血小板活化因子受体基因的表达变化.中华消化杂志,2006,26(11):769-770.
29.Dobosz M,Mionskowski L,Hac S,et al.Heparin improves organ micrcirculatory disturbances in caerulein-induced acute pancreatitis in rats.World Gastroentrol,2004,10(17):2553-2556.
30.Satoh A,Shimosegawa T,Fujita M,et al.Inhibition of nuclear factor-Kappa B activation improves the survival of rats with taurocholate pancreatitis.Gut,1999,44(2):253-258.
31.Algul H,Tando Y,Schneider G.Acute experimental pancreatitis and NF- kappaB/Rel activation.Pacreatology,2002,2:503-509.
32.薛育政,刘宗良,黄中伟,等.核转录因子-κB在大鼠急性重症胰腺炎中的表达.中国危重病急救医学,2007,19(3):176-177.
33.Letoha T,Somlai C,Takacs T,et al.A nuclear import inhibitory peptide ameliorates the severity of cholecyctokinin-induced acute pancreatitis.World Gastroentrol,2005,11(7):990-999.
34.Ehridge RT,Hashimoto K,Chung DH,et al.Selective inhibition of NF-KappaB attenuates the severity of cerulean-induced acute pancreatitis.Am Coll Surg,2002,195:497-505.
35.Kusnierz-Cabala B,Naskalski JW,Kedra B.Comparison of sensitivity and specificity of serum poly-C avid ribonuclease activity and C-reative protein concentration in detection of mild and severe acute pancreatitis.Clin Chem Lab Med,2004,42(5):549-555.
36.王宗立,钟玲红.急性胰腺炎患者血清C-反应蛋白测定的意义.浙江实用医学,2003,8(1):37.
37.唐星火,覃山羽,宁红建.评估C-反应蛋白在急性胰腺炎中的作用.广西医科大学学报,2006,23(2):327.
38.Papachristou GI,Whitcomb DC.Predictors of severity and necrosis in acute pancreatitis.Gastroenterol Clin North Am,2004,33(4):871-890.
39.Mayer JM,Raraty M,Slavin J,et al.Serum amyloid A is a better earty predictor of severity than C-reative protein in acute pancreatitis.Br J Surg,2002,89(2):163-171.
40.郭品娥,徐玉莲,张乐之,等.血清淀粉样蛋白A、C反应蛋白及细胞因子在急性胰腺炎中的变化.临床检验杂志,2003,21(4):241.
41.Schiesser M,Bimmler D,Frick TW,et al.Conformational changes of ncreatitis-associated protein(PAP)activated by trypsin lead to insoluble protein aggregates.Pancreas,2001,22(2):186-192.
42.Zenilman ME,Tuchman D,Zheng Q,et al.Comparison of reg Ⅰ and reg Ⅲ levels during acute pancreatitis in the rat Ann Surg,2000,232(5):646-652.
43.许春芳,朱兰香,张威.急性胰腺炎vW因子、P-选择素的变化及临床意义.胰腺病学,2003,3(2):84-86.
44.Reinhart K,Bayer O,Brunkhorst F,et al.Markers of endothelial damage in organ dysfunction and sepsis.Crit Care Med,2002,30(5 suppl):S302-312.
45.Johnson CD,Lempinen M,Imrie CW,et al.Urinary trypsinogen activation peptide as a marker of severe acute pancreatitis.Br J Surg,2004,91(8):1027-1033.
46.Pezzilli R,Venturi M,Morselli-Labat AM,et al.Serum trypsinogen activation peptide in the assessment of the diagnosis and severity of acute pancreatitis damage:a pilot study using a new determination technique.Pancreas,2004,29(4):298-305.
47.Saez J,Martinez J,Trigo C.A comparative study of the activation peptide of earbxypeptidase B and trypsinogen as early predictrs of the severity of acute pancreatitis.Pancreas,2004,29(1):e9-14.
48.Kylanpaa-Back ML,Takala A,Kemppainen E,et al.Procalcitonin strip test in the early detection of severe acute pancreatitis.Br J Surg,2001,88(2):222-227
49.Riche FC,Cholley BP,Laisne MJ,et al.Inflammatory cytokines,C reactive protein,and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis.Surgery,2003,133(3):257-262.
50.Ammori BJ,Becker KL,Kite P,et al.Calcitonin precursors:early markers of gut barrier dysfunction in patients with acute pancreatitis.Pancreas, 2003,27(3):239-243.
51.Ammori BJ,Becker KL,Kite P,et al.Calcitonin precursors in the prediction of severity of acute pancreatitis on the day admission.Br Surg,2003,124(3):725-736.
52.钱家鸣.急性胰腺炎的诊断思维.中国实用内科杂志,2004,24(12):708-710.
53.Balthazar EJ.Staging of acute pancreatitis.Radiol Clin North Am,2002,40(6):1199-1209.
54.王芝文,吕文涛,安维新,等.急性胰腺炎的CT分级诊断(附68例分析).中国医学影像学杂志,2006,14(3):228-231.
55.曾小松,王静.CT对急性胰腺炎的诊断价值.西部医学,2007,19(1):113-114.
56.韦英炜,黎听.螺旋CT在急性胰腺炎诊断中的应用价值.实用医技杂志,2006,13(10):1652-1653.
57.岳辉,陈志安,关长群.急性重症胰腺炎的临床病理分型及预后CT预测评估(附53例临床分析)。中国临床医学影像杂志,2002,13(4):271-273.
2.黄平,沈云志.重症急性胰腺炎的诊治进展.江苏医药,2003,29:536-537.
3.Imrie CW,Ferguson JC.Coxsackie and mums virus infection in prospective study of acute pancreatitis.Gut 1977,18:53-56.
4.褚琦,龚自华.实验性胰腺炎研究进展.见:上海科学技术文献出版社,上海,2001,89,105.
5.Ros E,Navarro S,Bru C,et al.Occult Microlithiasis in"idiopathic"acute pancreatitis:prevention of elapses by cholecystectomy or ursodeoxycholic acid therapy.Gastroenterology,1991,101:1701-1709.
6.Lee SP,Nicholls JF,Park HZ.Biliary sludge as a cause of acute pancreatitis.N Engl J Med,1992,326(9):589-593.
7.Bernard JP,Sahel J,Giovannini M,et al.Pancreas divisum is a probable cause of acute pancreatitis:a report of 137 cases.Pancreas 1990,5:248-254.
8.Nagar AB,Gorelick FS.Acute pancreatitis Current Opinion in Gastroenterology.Gastroenterology,2004,20:439-443.
9.Kamisawa Y.Clinical significance of the minor duodenal papilla and accessory pancreatic duct.J Gastroenterol,2004,39:605-615.
10.Kamisawa T,Amemiya K,Egawa N,et al.Pancreatitis associated with congenital abnormalities of the pancreatico-biliary system.Hepatobiliary Pancreat Surg,2005,12:99-102.
11.杨茂悟,李继强,范竹萍,等.重症胰腺炎并发浆膜腔积液58例临床分析.中华消化杂志,1998,18(5):278-280.
12.陈若川,赵海剑,方向,等.胰腺相关性腹水诱导大鼠肺损伤的实验研究.肝胆胰外科杂志.2005,17(4):282-284.
13.Slavin J,Ghaneh P,Sutton R,et al.Management of necrotizing pancreattis.Word Gastroenterol,2001,7(4):476-481.
14.程宝泉,钟宁.重症急性胰腺炎腹水对正常肾细胞影响.中国现代普通外科进展,2005,8(3):212-215.
15.刘殿冈,孙家邦,李非,等.胰腺炎相关性腹水对大鼠胃肠动力的影响.北京医学,2005,27(9):546-548.
16.黄鹤光,冷希圣.重症急性胰腺炎患者血和腹水一氧化氮的动态变化.中华实验外科杂志,2002,19(3):241-242.
17.Maringhim A,Ciambra M,Patti P,et al.Aseites,pleural and perieardial efusions in acute panereatitis,Dig Dis Sci,1996,41:848-852.
18.刘春萍,陆慰萱.消化系统疾病的肺部表现.临床内科杂志,2003,20(7):340-342.
19.李波,刘续宝.重症急性胰腺炎并发急性浆膜腔积液的诊断与处理.见:张肇达,严律南,刘续宝主编.急性胰腺炎.第1版.北京:人民卫生出版社,2004,223-224.
20.Kylanpaa Back ML,Kemppainen E,Puolakkainen P,et al.Based Laboratory Methods and Carboxypeptidase Activation Peptide in Acute Pancreatitis.J Pancreas,2002,3(2):34-48.
21.孙家邦,王亚军.重症急性胰腺炎的早期处理.首都医科大学学报,2007,28(1):42-46.
22.Piri M,Alhan E,Kucuktulu U,et al.The effects of somatostatin on the microperfusion of the pancreas during acute necrotizig pancreatitis in rats.Hepatogastroenterology,May-Jun:49(45):833-837.
23.Andoh A,Hata K,Shimada M,et al.Inhibitory effects of somatostation on tumor necrosis factor-alpha-induced interleukin-6 secretion in human pancreatic periacinar myofibroblasts.Int J Mol Med,2002,Jul;10(1):89-93.
24.王国品.急性胰腺炎现代治疗中的一些观点.中国急救医学,2001,21:434-435.
25.Ratschko M,Fenner T,Lankisch PG.The role of antibiotic prophylaxis in the treatment of acute pancreatitis.Gastroenterol C lin North Am,1999,28:641-659,ix-x.
26.Moody FG,Haley-Russell D,et al.Intestinal transit and bacterial translocation in obstructive pancreatitis Dig DIS Sci 1995,40;1799-1804
27.Garg PK,Khanna S,Bohidar NP,Muncy DM.Incidence,spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis.J Gastroenterol Hepatol,2001,sep;16(9):1055-1059.
28.王兴鹏.重视肠道衰竭在重症急性胰腺炎发病重的作用.中华消化杂志,2002,22(1):5-6.
29.陈晓理,冯凯祥.肠道动力学改变在急性胰腺炎的病程及治疗中的意义.中国普外基础与临床,1999,6(6):325-327.
30.严律南.重症急性胰腺炎手术指征和时机的选择.中华实用外科学杂志,1999:19(9):529.
31.中华医学会消化病分会急性胰腺炎诊治指南.胰腺病学,2003,3(增刊):S89-S92.
32.张圣道.重症急性胰腺炎诊治指南增补修订的说明.胃肠病学,2006,6(增刊):S5-S6.
33.UK Working party on Acute Pancreatitis.UK guidelines for the management of acute pancreatitis,GUT 2005,54(SupplⅢ):ⅲ1-ⅲ9.
34.Raraty MG,Connor S,Criddle DN,et al.Acute pancreatitis and organ failure pathophysiology,natural history,and management strategies.Curr Gastoenterol Rep,2004,699-103.
35.Sultan S,Baillie J.What the predictors of post-EKCP pancreatitis,and how useful are they.Jop,2002,3(6):188.
36.Balteskard L,Unneberg K,Mjaaland M,et al.Growth hormone and ingulinlike growth factor-1 promote intestinal uptake and hepatic release of glutamine in sepsis.Ann Surg,1998,228(1):131-139.
37.Zhang QH,Cai D.Protect role of multiple organ dysfunction syndrome on acute necrotizing pancreatitis with somatostatin and growth hormone.Int J pancreatol,1998,23:288-289.
38.Bosscharm K,Halstaett PE,Hennipinan A,et al.Fulminant acute pancreatitis and infected necresis:results of management of abdoment and "Planned"reparations.J Am Coil Stag,1998,(187):255-262.
39.张圣道,汤耀卿,李宏为,等.特重型急性胰腺炎救治措施探讨(附一例报告).外科理论与实践,2000,5:97-99.
40.彭淑牖,牟一平,蔡秀军.重视暴发性急性胰腺炎的诊断和治疗.外科理论与实践,2001,6:68-70.
41.Shields CJ,Winter DC,Redmond HP.Systemic complications of acute pancreatitis,Curr Opin Crit Care.2002,8:158-163.
42.孙家邦,朱斌.暴发性胰腺炎诊治关键探索.中国实用外科杂志,2003,23(1):53-55.
43.Windor JA,Hammodat HH.Metabolic management of severe acute pancreatitis.World J Surg,2000,24:46-48.
44.Mark A,Malangoni,Adam S,et al.Pancreatitis.Am J Surg,2005,189(3):273-277.
1.Soumitra RE,Lynn JH,Philip SB.Severity scoring for prognostication in patients with severe acute pancreatitis:comparative analysis of the Ranson score and the APACHE Ⅱ score.Archives of Surgery,2002,137(6):730-737.
2.李明贤,贾林.重症急性胰腺炎的临床发病学特征及预后分析.中国综合临床,2006,22(10):902-904.
3.中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南.中华消化杂志,2004,24(3):190-192.
4.张圣道,张臣烈,汤耀卿,等.急性坏死性胰腺炎全病程演变及治疗对策.中华外科杂志,1997,35(3):156-157.
5.Kiriyama S,Kumada T,Tanikawa M.Recent advances in biochemical diagnosis and assessment of severity in acute pancreatitis.Nippon Rinsho,2004,62(11):2035-2039.
6.张肇达,严律南主编.急性胰腺炎.第1版.北京:人民卫生出版社,2004,59.
7.Rau B,Schilling MK,Beggr HG,et al.Laboratory markers'of severe acute pancreatitis.Dig Dis,2004,22(3):247-257.
8.曲永柏,董琦,隋武,等.血清IL-6、TNF-α测定对急性重症胰腺炎预后评价的意义.宁夏医学杂志,2005,27(6):383-385.
9.刘香萍,汪小娟,胡钶,等.重症胰腺炎血清sICAM-1、IL-6、YNF-α含量的变化和意义.临床医学研究,2006,23(1):40-42.
10.高勇,周波,叶世会.急性重症胰腺炎患者血清肿瘤坏死因子α、白细胞介素10水平变化及意义.中国临床医学,2006,13(5):761-762.
11.张晓云,汪东剑,余维涛.血清IL-6、IL-8、TNF-α在重症急性胰腺炎早期诊断中的临床意义.胰腺病学,2004,4(1):26-28.
12.Bbatia M,Shokuhi S,Shokuhi S.Inflammatory mediators in acute pancreatitis.J Path,2000,190 P:117-125.
13.Dembinski A,Warzecha Z,Ceranowicz P,et al.Pancreatic damage and regeneration in the course of ischemia-reperfusion induced pancreatitis in rats.J Physiol Pharmacol,2001,52(2):221-235.
14.Norman J,Fink G,Franz M,et al.Active interleukin-1 receptor required for maximal progression of acute pancreatitis.Ann Surg,1996,223(2):163-169.
15.Jiang CF,Shiau YC,Ng KW,et al.Serum interleukin-6 tumor necrosis factor alpha and C-reactive protein in early prediction of severity of acute pancreatitis.J Chin Med Assoc,2004,67(9):442-446.
16.Triester SL,Kowdley KV.Prognostic factors in acute pancreatitis.J Clin Gastroenterol,2002,34:167-176.
17.Nikou GC,Giamarellos-bourboulis EJ,Grecka P,et al.Effect of octreotide administration on serum interleukin-6(IL-6)levels of patients with acute edematous pancreatitis.Hepatogastroenterology,2004,51:599-602.
18.Gurleyik G,Cirpici OZ,Aktekin A,et al.The value of Ranson and APACHE-Ⅱ scoring systems,and serum levels of interleukin-6 and C-reactive protein in the early diagnosis of the severity of acute pancreatitis.Ulus Travma Derg,2004,10(2):83-88.
19.钟宏,陈喜志,刘国伟.重症急性胰腺炎患者血清TNF-α和IL-6水平的动态变化及临床意义.中国医药,2006,1(8):472-474.
20.Pooran N,Indaram A,Singh P,et al.Cytokines(IL-6,IL-8,TNF):early and reliable predictors of severe acute pancreatitis.ClinGastroeter,2003,37(3):263-266.
21.Naskalski JW,Kusnierz-Cabala B,Panek J,et al.Poly-C specific ribonuclease activity correlates with increased concentrations of IL-6,IL-8 and sTNFR55/sTNFR75 in plasma of patients with acute pancreatitis.Physiol Pharmacol,2003,54(3):439-448.
22.Han XC,Zhang YC,Wang Y,et al.Clinical evaluation of serum interleukin 10 in patients with acute pancreatitis.Hepatobiliary Pancereat Dis Int,2003,2(1):135-138.
23.Suzuki K,Nakaji S,Kurakake S,et al.Exhaustive exercise and type-1/type-2 cytokine balance with special focus on interleukin-12p40/p70.Exerc Immunol Rev,2003,9(1):48-57.
24.Uehara S,Gothoh K,Handa H,et al.Immune function in patients with acute pancreatitis.Gastroenterol Hepatol,2003,18(4):363-370.
25.贺丽,陈少夫,曹晓辉,等.急性胰腺炎患者IL-15、IL-18、STNF-1R的变化意义.世界华人消化杂志,2003,11(1):57-60.
26.Victorino GP,Newton CR,Curran B.Modulation of mircrovascular hydraulic permeability by platelet-activating factor.Trauma,2004,56(2):379-384.
27.Boccellino M,Biancone L,Cantaluppi V,et al.Effect of platelet-activating factor receptor expression on CHO cell motility.Cell Physiol,2000,83:254-264.
28.赵志伶,夏时海,陈虹.重症急性胰腺炎胰腺组织血小板活化因子受体基因的表达变化.中华消化杂志,2006,26(11):769-770.
29.Dobosz M,Mionskowski L,Hac S,et al.Heparin improves organ micrcirculatory disturbances in caerulein-induced acute pancreatitis in rats.World Gastroentrol,2004,10(17):2553-2556.
30.Satoh A,Shimosegawa T,Fujita M,et al.Inhibition of nuclear factor-Kappa B activation improves the survival of rats with taurocholate pancreatitis.Gut,1999,44(2):253-258.
31.Algul H,Tando Y,Schneider G.Acute experimental pancreatitis and NF- kappaB/Rel activation.Pacreatology,2002,2:503-509.
32.薛育政,刘宗良,黄中伟,等.核转录因子-κB在大鼠急性重症胰腺炎中的表达.中国危重病急救医学,2007,19(3):176-177.
33.Letoha T,Somlai C,Takacs T,et al.A nuclear import inhibitory peptide ameliorates the severity of cholecyctokinin-induced acute pancreatitis.World Gastroentrol,2005,11(7):990-999.
34.Ehridge RT,Hashimoto K,Chung DH,et al.Selective inhibition of NF-KappaB attenuates the severity of cerulean-induced acute pancreatitis.Am Coll Surg,2002,195:497-505.
35.Kusnierz-Cabala B,Naskalski JW,Kedra B.Comparison of sensitivity and specificity of serum poly-C avid ribonuclease activity and C-reative protein concentration in detection of mild and severe acute pancreatitis.Clin Chem Lab Med,2004,42(5):549-555.
36.王宗立,钟玲红.急性胰腺炎患者血清C-反应蛋白测定的意义.浙江实用医学,2003,8(1):37.
37.唐星火,覃山羽,宁红建.评估C-反应蛋白在急性胰腺炎中的作用.广西医科大学学报,2006,23(2):327.
38.Papachristou GI,Whitcomb DC.Predictors of severity and necrosis in acute pancreatitis.Gastroenterol Clin North Am,2004,33(4):871-890.
39.Mayer JM,Raraty M,Slavin J,et al.Serum amyloid A is a better earty predictor of severity than C-reative protein in acute pancreatitis.Br J Surg,2002,89(2):163-171.
40.郭品娥,徐玉莲,张乐之,等.血清淀粉样蛋白A、C反应蛋白及细胞因子在急性胰腺炎中的变化.临床检验杂志,2003,21(4):241.
41.Schiesser M,Bimmler D,Frick TW,et al.Conformational changes of ncreatitis-associated protein(PAP)activated by trypsin lead to insoluble protein aggregates.Pancreas,2001,22(2):186-192.
42.Zenilman ME,Tuchman D,Zheng Q,et al.Comparison of reg Ⅰ and reg Ⅲ levels during acute pancreatitis in the rat Ann Surg,2000,232(5):646-652.
43.许春芳,朱兰香,张威.急性胰腺炎vW因子、P-选择素的变化及临床意义.胰腺病学,2003,3(2):84-86.
44.Reinhart K,Bayer O,Brunkhorst F,et al.Markers of endothelial damage in organ dysfunction and sepsis.Crit Care Med,2002,30(5 suppl):S302-312.
45.Johnson CD,Lempinen M,Imrie CW,et al.Urinary trypsinogen activation peptide as a marker of severe acute pancreatitis.Br J Surg,2004,91(8):1027-1033.
46.Pezzilli R,Venturi M,Morselli-Labat AM,et al.Serum trypsinogen activation peptide in the assessment of the diagnosis and severity of acute pancreatitis damage:a pilot study using a new determination technique.Pancreas,2004,29(4):298-305.
47.Saez J,Martinez J,Trigo C.A comparative study of the activation peptide of earbxypeptidase B and trypsinogen as early predictrs of the severity of acute pancreatitis.Pancreas,2004,29(1):e9-14.
48.Kylanpaa-Back ML,Takala A,Kemppainen E,et al.Procalcitonin strip test in the early detection of severe acute pancreatitis.Br J Surg,2001,88(2):222-227
49.Riche FC,Cholley BP,Laisne MJ,et al.Inflammatory cytokines,C reactive protein,and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis.Surgery,2003,133(3):257-262.
50.Ammori BJ,Becker KL,Kite P,et al.Calcitonin precursors:early markers of gut barrier dysfunction in patients with acute pancreatitis.Pancreas, 2003,27(3):239-243.
51.Ammori BJ,Becker KL,Kite P,et al.Calcitonin precursors in the prediction of severity of acute pancreatitis on the day admission.Br Surg,2003,124(3):725-736.
52.钱家鸣.急性胰腺炎的诊断思维.中国实用内科杂志,2004,24(12):708-710.
53.Balthazar EJ.Staging of acute pancreatitis.Radiol Clin North Am,2002,40(6):1199-1209.
54.王芝文,吕文涛,安维新,等.急性胰腺炎的CT分级诊断(附68例分析).中国医学影像学杂志,2006,14(3):228-231.
55.曾小松,王静.CT对急性胰腺炎的诊断价值.西部医学,2007,19(1):113-114.
56.韦英炜,黎听.螺旋CT在急性胰腺炎诊断中的应用价值.实用医技杂志,2006,13(10):1652-1653.
57.岳辉,陈志安,关长群.急性重症胰腺炎的临床病理分型及预后CT预测评估(附53例临床分析)。中国临床医学影像杂志,2002,13(4):271-273.