重症急性胰腺炎体液隔离危害性的临床分析
|
摘要
目的:分析重症急性胰腺炎(severe acute pancreatitis,SAP)体液隔离的危害。方法:回顾性分析我院1995年1月至2000年1月53例SAP临床资料。按治疗结果分为早期死亡、晚期死亡、治愈3个组;统计3组入院后的前3d总出入量和体液隔离量以及治疗48h前后红细胞压积(Hematocrit,HCT)的变化:分析早期死亡和后期死亡的原因。结果:早期死亡组和晚期死亡组体液隔离持续48h以上,早期死亡组、晚期死亡组和治愈组在48h体液隔离量分别为:10078.3±1616.2ml、6124.4±1081.1ml和4719.7±1397.7ml,3组相比差异有统计学意义(p＜0.05)。早期死亡6例,多与心跳骤停和呼吸衰竭有关:晚期死亡12例多与感染有关。结论:体液隔离的实质是细胞外液病理性再分布和细胞外液增加;体液隔离的危害在早期为组织间隙体液大量急性贮留导致细胞、组织肿胀,心和肺功能受到致命的影响,在晚期增加感染的机会。
Objective:To analysis fluid sequestration in severe acute pancreatitis(SAP). Methods:A retrospective review was conducted of 53 patients with SAP between January 1995 and January 2000.According to the outcomes,the patients was divided into early death group,later death group and survival group.Fluid intake,fluid output and fluid sequestration were measured within initial 72 hours in the three groups. Results:Fluid sequestration in the early death group and later death group lasted for 48 hours or more.The mean fluid sequestration within initial 48 hours in the three groups was 10078.3±1616.2ml,6124.4±1081.1ml and 4719.7±1397.7ml,respectively. These changes were statistically different(p＜0.05).Six patients died of cardiac arrest and respiratory failure in the early death group,and twelve died of infection in the later death group.Conclusions:The essence of fluid sequestration is pathological redistribution of extracellular fluid and expanding of extracellular fluid volum.A large amount of fluid storages acutely in interstitial space causes cell swelling and tissue edema,may result in fatal influence on cardic and pulmonary function in the early stage,and may add to the chance of infection in the latter period.
Objective:To analysis fluid sequestration in severe acute pancreatitis(SAP). Methods:A retrospective review was conducted of 53 patients with SAP between January 1995 and January 2000.According to the outcomes,the patients was divided into early death group,later death group and survival group.Fluid intake,fluid output and fluid sequestration were measured within initial 72 hours in the three groups. Results:Fluid sequestration in the early death group and later death group lasted for 48 hours or more.The mean fluid sequestration within initial 48 hours in the three groups was 10078.3±1616.2ml,6124.4±1081.1ml and 4719.7±1397.7ml,respectively. These changes were statistically different(p＜0.05).Six patients died of cardiac arrest and respiratory failure in the early death group,and twelve died of infection in the later death group.Conclusions:The essence of fluid sequestration is pathological redistribution of extracellular fluid and expanding of extracellular fluid volum.A large amount of fluid storages acutely in interstitial space causes cell swelling and tissue edema,may result in fatal influence on cardic and pulmonary function in the early stage,and may add to the chance of infection in the latter period.
引文
铩颷1]张圣道.重症急性胰腺炎诊治草案(2000年杭州会议).胰腺病学,2001,1(1):46
[2]Riche FC,Choney BP,Laisne MJ,et al.Inflammatory cytokines,C reativeprotein,and procalcitonin as early predictors of necross infection in acutenecrotizing pancreatitis[J].Surgery,2003,133(3):257-262
[3]Chiang DT,Anozie A,Fleming WR,et al.Comparative study on Acute pancreatitismanagement.ANZ J Surg,2004,74:218-221
[4]张肇达,严律南,刘继宝主编.《急性胰腺炎》,北京,人民卫生出版社,2004
[5]郭应禄,祝光学主编.《外科学》(北京大学医学教材),北京,北京大学医学出版社,2003
[6]Ranson JH,Pasternack BS.Statistical methods for quantifying the severity ofclinical pancreatitis[J].J Surg Res.1977,22:79-91
[7]Ranson J H,Rifkind K M,Rose D F,et al.Prognostic signs and the role ofoperative management in acute pancreatitis[J].Surg Gynecol obstet,1974,139(1):69-81
[8]Ranson J H,Rifkind K M,Turner J W.Prognostic signs and monoperativeperitoneal lavage in acute pancreatitis[J].Surg Gynecol obstet,1976,143(2):209-219
[9]Sauven P,Playforth M J,Evans M,et al.Fluid sequestation:an early indicator ofmortality in acute pancreatitis[J].Br J Surg,1986,73(10):799-800
[10]Fojtzik T,Eibl G,Hotz H G,et al.Endothelin receptor blockade in severe acutepancreatitis leads to systemic enhancement of microcirculation,stabilization ofcapillary permeability,and improved survival rates[J].Surgery,2000,128(3):399-407
[11]Eachempati S R,Hydo L J,Barie P S.Severity scoring for prognostication inpatients with severe acute pancreatitis:Comparative analysis of the Ranson scoreand the APACHEⅡ score[J].Arch Surg,2002,137(6):730-736
[12]王喜艳,徐新建,温浩,等.重症急性胰腺炎急性反应期体液代谢变化的初步观察[J].中国普通外科杂志,2004,13(10):780-782
[13]Hong J J,Cohn S M,Perez J M,et al.Prospective study of the incidenceoutcome of intra-abdomonal hypertansion and the abdominal compartmentsyndrome[J].Br J Surg,2002,89(6):591-596
[14]Greenstein R J,Krakoff L R,Felton K.Activation of the renin system in acute pancreatitis[J].Am J Med,1987,Mar,82(3):401-404
铩颷15]王喜艳,徐新建,温浩,等.重症急性胰腺炎肝脏体积的变化及临床意义[J].中华普通外科杂志,2005,20(8):533-534
[16]Hillebrecht A,Schulz H,Meyer M,et al.Pulmonary Responses to lowerbody negative pressure and Fluid loading during head-down tilt bedrest[J].ActaPhysiol Scand Suppl,1992,604:35-42
[17]Jordan S,Mitchell J A,Quinlan G J,et al.The Pathogenesis of lung injuryfollowing pulmonary resection[J].EurRespirJ,2000,15(4):790-799
[18]Lobo D N,Bostock K A,Neal K R,et al.Effect of Salt and water balance onrecovery of gastrointestinal Function after elective colonic resection:a randomizedControlled trial[J].Lancet,2002,359(9320):1812-1818
[19]Mckay C J,Imrie C W.The continuing challenge of Early mortality in acutepancreatitis[J].Br J Surg,2004,91(10):1243-1244.
[20]Gloor B,Muller C A,Worni M,et al.Late mortality inpatients with severe acutepancreatitis[J].Br J Surg,2001,88(7):975-979.
铩颷1]Rothermich No,Von Haame.Pancreatic encephaloputhy[J].J Clin Endocrinol,1941,1:873-881
[2]Menza MA,Murraay GB.Pancreatic encephalopathy[J].Biol Psychiatry,1989,25:781-784
[3]Chen LD,Zhang XQ.Pancreatic encephalopathy and wemicke encephalopathy.Chin J Intern Med,2002,41:94-97
[4]Saez Royula-Gonzalo F,Gomez-Rodriguez R,Gomez- Rubio M,et al.Complicatiom of acute pancreatitis[A].In:Frequency moment of onset andmultiplicity[J].Rev Clin Esp,1989,184:280-284
[5]王平,崔彦.胰性脑病研究进展.肝胆胰外科杂志,2002,14:126-127
[6]Pitchumoni CS,Agarwai N,Jain NK.System in complications of acutepancreatitis.Am J Gastroenterol,1988,83:597-601
[7]Goke B,Meyer T,Loth H,et al.Characterization of phospho- lipase A2activity in aspirates of human pancreatic pseudocysts after isolation byreversed-phase high performance liquid chromatography.Klin Wochenschr,1989,67:131-135
[8]Nevalainen TJ.Phospholase A2 in acute pancreatitis.Scand J Gastroenterol,1988,23:897-904
[9]苗毅,钱祝银,刘训民,等.胰性脑病动物模型的制备.中华实验外科杂志,1997,14:235
[10]赵海平,王万祥,刘淑平,等.磷脂酶A2对大鼠胰性脑病的作用.中国病理生理杂志,1998,14:684
[11]刘文东,董振明,陈金良,等.重症胰腺炎麻醉手术后并发胰性脑病的原因分析:附2例报告.河北医药,1996,18:348-49
[12]金世龙,宋小文,顾红光,等.急性重症胰腺炎胰性脑病13例.世界华人消化杂志,2000,8:721-722
[13]Norman J.The role of cytokines in the pathogenesis of acute pancreatitis.Am JSurg,1998,175:76-83
[14]Farkas G,Marton J,Nagy Z,et al.Experimental acute pancreatitis results inincreased blood-brain barrier permeability in the rat:a potential role for turn ornecrosis factor and interleuk in 6.Neurosci Lett,1998,242:147-150
[15]成俊,周亚魁,陈纪伟,等.TNF-a,IL-1在胰性脑病发病机制中的作用.中国普通 外科杂志,2002,11:142-145
铩颷16]Victor M.Persistent altered mention due to ethanol[J].Neurol Clin,1993,11:639-641
[17]Lee YD,Lee SO,Lee ST.Wemicke,s encephalopathy:acomplication ofacute pancreatitis? Hosp Med,2003,64:372-373
[18]Ogershok PR,Rahman A,Nestor S,et al.Wemicke encephalopathy innonalcoholic patients.Am J Med sci,2002,323:107-111
[19]Hoerauf A,Mammer S,Muller Myhpok B,et al.Inter abdominal candida infectionduring acute necreatitis has a high prevalence and is associated wit increasedmortality[J].Crit Care Med,1998,26:2010-2015
[20]Filley CM.Toxic leukoencephalopathy[J].M Engl J Med,2001,345:425-432
[21]Xue YD,Wang GZ,Chen HL,et al.Clinical chatacteristic and diagnosis ofwemicke encephalopathy in nonalcoholic patients.J Apopl Nerv Dis,2001,18:115-116
[22]刘训良,钱祝银,苗毅,等.重症急性胰腺炎患者血清髓鞘碱性蛋白含量测定及临床意义.中华实验外科杂志,1997,14:203-204
[23]卢崇亮,何庆忠.胰性脑病的研究现状.中国普通外科杂志,2001,10:362-365
[24]Johnson DA,Tong NT.Pancreatic encephalopathy.South Med J,1977,70:165-167
[25]钱祝银,苗毅,刘训民,等.胰性脑病时脑脊髓病变的实验研究.外科理论与实践,2001,6:114-115
[26]Azim W,Walker R.Wemicke,s encephalopathy:a frequently missed problem.Hosp Med,2003,64:326-327
[27]李子禹.胰性脑病.中华肝胆外科杂志,1999,5:142-143
[28]徐肇敏.重症急性胰腺炎后胰腺假性囊肿和胰性脑病的处理.中国冶金工业医学杂志,2004,21:469-469
[29]钱祝银,苗毅,刘训民,等.胰性脑病临床治疗的探讨.中国现代普通外科进展,2001,4:99-100
[30]余德刚,蔡庆勇,钱永琴,等.胰性脑病的中西医结合治疗.现代中西医结合杂志,2000,9:1106-7
铩颷1]Chiang DT,Anozie A,Fleming W R,et al.Comparative study on Acutepancreatitis management.ANZ J Surg,2004,74:218-221
[2]张圣道.重症急性胰腺炎诊治草案(2000年杭州会议).胰腺病学,2001,1(1):46
[3]Ranson JHC,Pastemack BS.Statisticalmethod squantifying the severity of clinicalacute pancreatitis.J Surg Kes,1997,22:79
[4]王兴鹏.急性胰腺炎实验与临床研究的现状[M],袁耀宗 主编.胰腺病学新进展与新技术.上海:上海科学技术文献出版社.2001.114
[5]董江宁,孔学英,熊克仁,等.急性出血坏死性胰腺炎CT动态复查的价值.实用放射学杂志,2004,20:130-132
[6]Muller C,Uhi W,Gloor B,et al.Acute pancreatitis clinical and technicallaboratory diagnostic and prognostic assessnen.Swiss Surg,2000,6:235-240
[7]BALTHAZAR EJ.Staging of acute pancieatitia[J].Radiol Clin North Am,2002,40(6):1199
[8]Imamura T,Tanaka S,Yoshida H,et al.Significance of measurement ofhigh-sensitivity C-reactive protein in acutepancrcatitis.J Castroenterol,2002,37(11):935
[9]Khan Z,Vlodov J,Horovitz J,et al.Urinarv trypsinogen activation peptide ismore accurate than hematocrit in determining severity in patients with acutepancrcatitis:a prospective study.Am J Castrocnterol,2002,97(8):I973
[10]MULLER C,UHL W,GLOOR B,et al.Acute pancteatitis-clinical and technicallaboratory diagnostic and prognostic assessment[J].Swiss Surg,2000,6(5):235
[11]严律南.重症急性胰腺炎的治疗观点:非手术、手术、个体化[J]?中国实用外科杂志,2001,21(1):21
[12]江从庆,艾中生,刘志苏,等.重症急性胰腺炎的早期危险因素-血液浓缩[J].中国实用外科杂志,2001,21(11):666-667
[13]夏天,严律南.SAP血流动力学变化特点与液体复苏应注意的问题[J].中国实用外科杂志,2003,23(9):524-526
[14]巫协宁.重症急性胰腺炎的发病机制[J].中华消化杂志,1999,19:335
[15]瞿洪平,汤耀卿.重症急性胰腺炎的早期肠内营养支持[J].中国实用外科杂志,2003,23(9):522-524
[16]Kingsnorth AN,Galloway SW,Formela LJ.Randomized double-blind Phase Ⅱ trial of Lexipafant a platelet activating factor antagonist in human acute
pancreatitis[J].Br J Surg,2005,82:1414
铩颷17]戴军,茅益民,曾民德,等.阿托莫兰治疗慢性肝病的逆效观察[J].胃肠病学,2000,5(1):62
[18]Dittrich E,Schmaldienst S,Langer M,et al.Immunoadsorption and plasmaexchange in pregnancy[J].Kidney Blood Press Res,2002,25(4):232-239
[19]Jaber BL,Pereira BJ.Extracorporeal absorbent-based strategies in sepsis[J].AmJ Kidney Dis,2003,30(5Supp14):44-56
[20]Bellomo R,Ronco C.Continuous renal replacement therapy:continuous bloodpurification in the intensive careunit[J].Ann Acad Med Singapore,2002,27(3):426-429
[21]Free DD,Cuesto MA.Evaluation of severity in patients with acute pancreantitis[J].Am J Gastroenterol,2005,87:604
[22]Kaiser A M.Relationship between severity,necrosis,and apoptosis in five modelsof experimental acute pancreatitis[J].Am J Physiol,1995,269:1 295-1 304
[23]Sheu JR.Mechnism involved in the antiplatelet activity of naloxone in humanplatelets[J].Biochem Biophys Res Commun,2002,23(1):12
[24]Soetikno RM,Cart-Locke DL.Endoscopic management of acute gallstonepancreatitis.Gastrointest Endosc Clin N Am,2003,8(1):1-12
[25]Takagi K,Isaji S.Therapeutic efficacy of continous arterial infusion of anantibiotic and aprotease inhibitor via the superior mesenteric artery for acutepancreatitis in an animal model.Pancreas,2004,21:279-289
[26]Mithofer K,Mueller PR,Warshaw AL.Interventional and surgical treatment ofpancreatic abscess.World J Surg,1997,21:162-168
[27]Liulko VI,Kosulnikov SO,Volik ON.Minimally invasive surgical procedures inthe treatment of destructive pancreatitis.Klin Khir,2003,3:24-25
[28]Kraas E,Frauenschch D.Surgery of the gallbladder and bile ducts by minimallyinvasive surgery.Chirurg,2001,72:378
[29]Will U,Meyer F,Manager T,et al.Endoscopic ultrasound-assisted rendezvousmaneuver to achieve pancreatic duct drainge in obstructive chronic pancreatitis.Endoscopy,2005,37:171-173
[30]张圣道,张臣烈,杨毓兴,等.139例急性坏死性胰腺炎外科治疗总结治疗观点的改变.中华外科杂志,1991,29:54-55
[31]黎介寿,李维勤.重症急性胰腺炎手术指征和时机的再认识[J].中国实用外 科杂志,2003,23(9):513-514
铩颷32]雷若庆,张圣道.胰腺坏死感染的手术指征、时机和方式选择[J].中国实用外科杂志,2003,23(9):518-520
[2]Riche FC,Choney BP,Laisne MJ,et al.Inflammatory cytokines,C reativeprotein,and procalcitonin as early predictors of necross infection in acutenecrotizing pancreatitis[J].Surgery,2003,133(3):257-262
[3]Chiang DT,Anozie A,Fleming WR,et al.Comparative study on Acute pancreatitismanagement.ANZ J Surg,2004,74:218-221
[4]张肇达,严律南,刘继宝主编.《急性胰腺炎》,北京,人民卫生出版社,2004
[5]郭应禄,祝光学主编.《外科学》(北京大学医学教材),北京,北京大学医学出版社,2003
[6]Ranson JH,Pasternack BS.Statistical methods for quantifying the severity ofclinical pancreatitis[J].J Surg Res.1977,22:79-91
[7]Ranson J H,Rifkind K M,Rose D F,et al.Prognostic signs and the role ofoperative management in acute pancreatitis[J].Surg Gynecol obstet,1974,139(1):69-81
[8]Ranson J H,Rifkind K M,Turner J W.Prognostic signs and monoperativeperitoneal lavage in acute pancreatitis[J].Surg Gynecol obstet,1976,143(2):209-219
[9]Sauven P,Playforth M J,Evans M,et al.Fluid sequestation:an early indicator ofmortality in acute pancreatitis[J].Br J Surg,1986,73(10):799-800
[10]Fojtzik T,Eibl G,Hotz H G,et al.Endothelin receptor blockade in severe acutepancreatitis leads to systemic enhancement of microcirculation,stabilization ofcapillary permeability,and improved survival rates[J].Surgery,2000,128(3):399-407
[11]Eachempati S R,Hydo L J,Barie P S.Severity scoring for prognostication inpatients with severe acute pancreatitis:Comparative analysis of the Ranson scoreand the APACHEⅡ score[J].Arch Surg,2002,137(6):730-736
[12]王喜艳,徐新建,温浩,等.重症急性胰腺炎急性反应期体液代谢变化的初步观察[J].中国普通外科杂志,2004,13(10):780-782
[13]Hong J J,Cohn S M,Perez J M,et al.Prospective study of the incidenceoutcome of intra-abdomonal hypertansion and the abdominal compartmentsyndrome[J].Br J Surg,2002,89(6):591-596
[14]Greenstein R J,Krakoff L R,Felton K.Activation of the renin system in acute pancreatitis[J].Am J Med,1987,Mar,82(3):401-404
铩颷15]王喜艳,徐新建,温浩,等.重症急性胰腺炎肝脏体积的变化及临床意义[J].中华普通外科杂志,2005,20(8):533-534
[16]Hillebrecht A,Schulz H,Meyer M,et al.Pulmonary Responses to lowerbody negative pressure and Fluid loading during head-down tilt bedrest[J].ActaPhysiol Scand Suppl,1992,604:35-42
[17]Jordan S,Mitchell J A,Quinlan G J,et al.The Pathogenesis of lung injuryfollowing pulmonary resection[J].EurRespirJ,2000,15(4):790-799
[18]Lobo D N,Bostock K A,Neal K R,et al.Effect of Salt and water balance onrecovery of gastrointestinal Function after elective colonic resection:a randomizedControlled trial[J].Lancet,2002,359(9320):1812-1818
[19]Mckay C J,Imrie C W.The continuing challenge of Early mortality in acutepancreatitis[J].Br J Surg,2004,91(10):1243-1244.
[20]Gloor B,Muller C A,Worni M,et al.Late mortality inpatients with severe acutepancreatitis[J].Br J Surg,2001,88(7):975-979.
铩颷1]Rothermich No,Von Haame.Pancreatic encephaloputhy[J].J Clin Endocrinol,1941,1:873-881
[2]Menza MA,Murraay GB.Pancreatic encephalopathy[J].Biol Psychiatry,1989,25:781-784
[3]Chen LD,Zhang XQ.Pancreatic encephalopathy and wemicke encephalopathy.Chin J Intern Med,2002,41:94-97
[4]Saez Royula-Gonzalo F,Gomez-Rodriguez R,Gomez- Rubio M,et al.Complicatiom of acute pancreatitis[A].In:Frequency moment of onset andmultiplicity[J].Rev Clin Esp,1989,184:280-284
[5]王平,崔彦.胰性脑病研究进展.肝胆胰外科杂志,2002,14:126-127
[6]Pitchumoni CS,Agarwai N,Jain NK.System in complications of acutepancreatitis.Am J Gastroenterol,1988,83:597-601
[7]Goke B,Meyer T,Loth H,et al.Characterization of phospho- lipase A2activity in aspirates of human pancreatic pseudocysts after isolation byreversed-phase high performance liquid chromatography.Klin Wochenschr,1989,67:131-135
[8]Nevalainen TJ.Phospholase A2 in acute pancreatitis.Scand J Gastroenterol,1988,23:897-904
[9]苗毅,钱祝银,刘训民,等.胰性脑病动物模型的制备.中华实验外科杂志,1997,14:235
[10]赵海平,王万祥,刘淑平,等.磷脂酶A2对大鼠胰性脑病的作用.中国病理生理杂志,1998,14:684
[11]刘文东,董振明,陈金良,等.重症胰腺炎麻醉手术后并发胰性脑病的原因分析:附2例报告.河北医药,1996,18:348-49
[12]金世龙,宋小文,顾红光,等.急性重症胰腺炎胰性脑病13例.世界华人消化杂志,2000,8:721-722
[13]Norman J.The role of cytokines in the pathogenesis of acute pancreatitis.Am JSurg,1998,175:76-83
[14]Farkas G,Marton J,Nagy Z,et al.Experimental acute pancreatitis results inincreased blood-brain barrier permeability in the rat:a potential role for turn ornecrosis factor and interleuk in 6.Neurosci Lett,1998,242:147-150
[15]成俊,周亚魁,陈纪伟,等.TNF-a,IL-1在胰性脑病发病机制中的作用.中国普通 外科杂志,2002,11:142-145
铩颷16]Victor M.Persistent altered mention due to ethanol[J].Neurol Clin,1993,11:639-641
[17]Lee YD,Lee SO,Lee ST.Wemicke,s encephalopathy:acomplication ofacute pancreatitis? Hosp Med,2003,64:372-373
[18]Ogershok PR,Rahman A,Nestor S,et al.Wemicke encephalopathy innonalcoholic patients.Am J Med sci,2002,323:107-111
[19]Hoerauf A,Mammer S,Muller Myhpok B,et al.Inter abdominal candida infectionduring acute necreatitis has a high prevalence and is associated wit increasedmortality[J].Crit Care Med,1998,26:2010-2015
[20]Filley CM.Toxic leukoencephalopathy[J].M Engl J Med,2001,345:425-432
[21]Xue YD,Wang GZ,Chen HL,et al.Clinical chatacteristic and diagnosis ofwemicke encephalopathy in nonalcoholic patients.J Apopl Nerv Dis,2001,18:115-116
[22]刘训良,钱祝银,苗毅,等.重症急性胰腺炎患者血清髓鞘碱性蛋白含量测定及临床意义.中华实验外科杂志,1997,14:203-204
[23]卢崇亮,何庆忠.胰性脑病的研究现状.中国普通外科杂志,2001,10:362-365
[24]Johnson DA,Tong NT.Pancreatic encephalopathy.South Med J,1977,70:165-167
[25]钱祝银,苗毅,刘训民,等.胰性脑病时脑脊髓病变的实验研究.外科理论与实践,2001,6:114-115
[26]Azim W,Walker R.Wemicke,s encephalopathy:a frequently missed problem.Hosp Med,2003,64:326-327
[27]李子禹.胰性脑病.中华肝胆外科杂志,1999,5:142-143
[28]徐肇敏.重症急性胰腺炎后胰腺假性囊肿和胰性脑病的处理.中国冶金工业医学杂志,2004,21:469-469
[29]钱祝银,苗毅,刘训民,等.胰性脑病临床治疗的探讨.中国现代普通外科进展,2001,4:99-100
[30]余德刚,蔡庆勇,钱永琴,等.胰性脑病的中西医结合治疗.现代中西医结合杂志,2000,9:1106-7
铩颷1]Chiang DT,Anozie A,Fleming W R,et al.Comparative study on Acutepancreatitis management.ANZ J Surg,2004,74:218-221
[2]张圣道.重症急性胰腺炎诊治草案(2000年杭州会议).胰腺病学,2001,1(1):46
[3]Ranson JHC,Pastemack BS.Statisticalmethod squantifying the severity of clinicalacute pancreatitis.J Surg Kes,1997,22:79
[4]王兴鹏.急性胰腺炎实验与临床研究的现状[M],袁耀宗 主编.胰腺病学新进展与新技术.上海:上海科学技术文献出版社.2001.114
[5]董江宁,孔学英,熊克仁,等.急性出血坏死性胰腺炎CT动态复查的价值.实用放射学杂志,2004,20:130-132
[6]Muller C,Uhi W,Gloor B,et al.Acute pancreatitis clinical and technicallaboratory diagnostic and prognostic assessnen.Swiss Surg,2000,6:235-240
[7]BALTHAZAR EJ.Staging of acute pancieatitia[J].Radiol Clin North Am,2002,40(6):1199
[8]Imamura T,Tanaka S,Yoshida H,et al.Significance of measurement ofhigh-sensitivity C-reactive protein in acutepancrcatitis.J Castroenterol,2002,37(11):935
[9]Khan Z,Vlodov J,Horovitz J,et al.Urinarv trypsinogen activation peptide ismore accurate than hematocrit in determining severity in patients with acutepancrcatitis:a prospective study.Am J Castrocnterol,2002,97(8):I973
[10]MULLER C,UHL W,GLOOR B,et al.Acute pancteatitis-clinical and technicallaboratory diagnostic and prognostic assessment[J].Swiss Surg,2000,6(5):235
[11]严律南.重症急性胰腺炎的治疗观点:非手术、手术、个体化[J]?中国实用外科杂志,2001,21(1):21
[12]江从庆,艾中生,刘志苏,等.重症急性胰腺炎的早期危险因素-血液浓缩[J].中国实用外科杂志,2001,21(11):666-667
[13]夏天,严律南.SAP血流动力学变化特点与液体复苏应注意的问题[J].中国实用外科杂志,2003,23(9):524-526
[14]巫协宁.重症急性胰腺炎的发病机制[J].中华消化杂志,1999,19:335
[15]瞿洪平,汤耀卿.重症急性胰腺炎的早期肠内营养支持[J].中国实用外科杂志,2003,23(9):522-524
[16]Kingsnorth AN,Galloway SW,Formela LJ.Randomized double-blind Phase Ⅱ trial of Lexipafant a platelet activating factor antagonist in human acute
pancreatitis[J].Br J Surg,2005,82:1414
铩颷17]戴军,茅益民,曾民德,等.阿托莫兰治疗慢性肝病的逆效观察[J].胃肠病学,2000,5(1):62
[18]Dittrich E,Schmaldienst S,Langer M,et al.Immunoadsorption and plasmaexchange in pregnancy[J].Kidney Blood Press Res,2002,25(4):232-239
[19]Jaber BL,Pereira BJ.Extracorporeal absorbent-based strategies in sepsis[J].AmJ Kidney Dis,2003,30(5Supp14):44-56
[20]Bellomo R,Ronco C.Continuous renal replacement therapy:continuous bloodpurification in the intensive careunit[J].Ann Acad Med Singapore,2002,27(3):426-429
[21]Free DD,Cuesto MA.Evaluation of severity in patients with acute pancreantitis[J].Am J Gastroenterol,2005,87:604
[22]Kaiser A M.Relationship between severity,necrosis,and apoptosis in five modelsof experimental acute pancreatitis[J].Am J Physiol,1995,269:1 295-1 304
[23]Sheu JR.Mechnism involved in the antiplatelet activity of naloxone in humanplatelets[J].Biochem Biophys Res Commun,2002,23(1):12
[24]Soetikno RM,Cart-Locke DL.Endoscopic management of acute gallstonepancreatitis.Gastrointest Endosc Clin N Am,2003,8(1):1-12
[25]Takagi K,Isaji S.Therapeutic efficacy of continous arterial infusion of anantibiotic and aprotease inhibitor via the superior mesenteric artery for acutepancreatitis in an animal model.Pancreas,2004,21:279-289
[26]Mithofer K,Mueller PR,Warshaw AL.Interventional and surgical treatment ofpancreatic abscess.World J Surg,1997,21:162-168
[27]Liulko VI,Kosulnikov SO,Volik ON.Minimally invasive surgical procedures inthe treatment of destructive pancreatitis.Klin Khir,2003,3:24-25
[28]Kraas E,Frauenschch D.Surgery of the gallbladder and bile ducts by minimallyinvasive surgery.Chirurg,2001,72:378
[29]Will U,Meyer F,Manager T,et al.Endoscopic ultrasound-assisted rendezvousmaneuver to achieve pancreatic duct drainge in obstructive chronic pancreatitis.Endoscopy,2005,37:171-173
[30]张圣道,张臣烈,杨毓兴,等.139例急性坏死性胰腺炎外科治疗总结治疗观点的改变.中华外科杂志,1991,29:54-55
[31]黎介寿,李维勤.重症急性胰腺炎手术指征和时机的再认识[J].中国实用外 科杂志,2003,23(9):513-514
铩颷32]雷若庆,张圣道.胰腺坏死感染的手术指征、时机和方式选择[J].中国实用外科杂志,2003,23(9):518-520