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Introducción: la necrosis pancreática se presenta entre 10 y 20 % de los pacientes con pancreatitis aguda, tiene una mortalidad de 10 a 25 % y si se agrega infección a la necrosis entre 40 y 70 %. Objetivo: describir el manejo clínico quirúrgico de la necrosis pancreática infectada en el Servicio de Cirugía General del Hospital Nacional entre el periodo 2021-2022. Metodología: estudio observacional descriptivo de corte temporal transversal. En pacientes internados en el Servicio de Cirugía General del Hospital Nacional por pancreatitis aguda grave con necrosis pancreática infectada. Resultados: se analizaron un total de 30 pacientes. La media de edad fue de 39 años. Predominó en nuestra población pacientes de sexo masculino en el 56.67 %. En cuanto a las comorbilidades asociadas un 33.3 % los pacientes presentaron principalmente Diabetes mellitus tipo 2 e Hipertensión arterial; en menor medida Obesidad en un 23.3 %. De la población en estudio 76.6 % recibieron tratamiento quirúrgico y 23.33% tratamiento médico principalmente antibiótico terapia. De los pacientes sometidos a tratamiento quirúrgico 9 fueron a necrosectomia abierta, 7 a drenaje percutáneo, y en menor medida drenaje biliar y endoscópico. En cuanto a la mortalidad por necrosis pancreática infectada encontramos un 10 % de mortalidad. Discusión: la mayor parte de los pacientes con pancreatitis aguda grave sufren de necrosis pancreática; la necrosis pancreática infectada se asocia con mayor riesgo de mortalidad y en su mayoría requieren tratamientos invasivos. Conclusión: el manejo mínimamente invasivo en el tratamiento inicial de la necrosis pancreática infectada podría resolver la mayoría de los casos sin necesidad de realizar necrosectomia; reservando esta última solo a los que fracasan en el tratamiento inicial.
Introduction: pancreatic necrosis occurs between 10 and 20 % of patients with pancreatitis, has a mortality of 10 to 25 % and if infection is added to the necrosis between 40 and 70 %. Objective: to describe the surgical and clinical management of infected necrotizing pancreatitis in patients admitted to the General Surgery Service of the Hospital Nacional between the period 2021-2022. Methodology: this was an observational, descriptive and cross-section study with a temporal cut. We included patients admitted to the general surgery service of the National Hospital with severe acute pancreatitis with infected necrotizing pancreatitis. Results: a total of 30 patients were included. The mean age was 39 years. Male patients prevailed in our population in 56.67 %. Regarding the associated comorbidities, 33.3 % of the patients presented mainly type 2 diabetes mellitus and arterial hypertension; to a lesser extent Obesity in 23.3 %. In the study population, 76.6 % received surgical treatment and 23.33 % medical treatment, mainly antibiotic therapy. Of the patients who underwent surgical treatment, 9 were open necrosectomy, 7 had percutaneous drainage, and to a lesser extent biliary and endoscopic drainage. Regarding mortality due to infected necrotizing pancreatitis, we found a 10% mortality. Discussion: most of the patients with severe acute pancreatitis suffer from necrotizing pancreatitis; infected necrotizing pancreatitis is associated with increased risk of mortality and most require invasive treatment. Conclusion: minimally invasive management in the initial treatment of infected necrotizing pancreatitis, which could resolve most cases without the need to perform necrosectomy; the latter should be reserved for those who fail the initial treatment.
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AIM: To investigate the interactive effects of blood glucose and blood calcium on the prognostic impact of patients with acute severe pancreatitis (SAP) and to analyze their predictive efficacy on prognosis. METHODS: One hundred and seven patients with SAP admitted to our hospital from September 2019 to October 2022 were selected for the study and were divided into poor and good groups according to their prognosis within 28 d. The blood glucose, blood calcium, modified Marshall score, bedside acute pancreatitis severity score (BISAP) were compared between the two groups before treatment, after 3 d of treatment, and after 7 d of treatment, and the correlation between blood glucose, blood calcium and modified Marshall score and BISAP score was analyzed. The blood glucose levels of patients with different blood calcium were compared. Cox regression was used to analyze the factors associated with prognosis. The presence and type of interaction between blood glucose and blood calcium on prognosis were analyzed using the interaction coefficient γ and relative risk (RR) values. The subject operating characteristic curve (ROC) was used to analyze the predictive efficacy of blood glucose and blood calcium on prognosis. RESULTS: The blood glucose, modified Marshall score, and BISAP score of the adverse group after treatment were higher than those of the good group, while the blood calcium was lower than that of the good group (P<0.05). After 3 and 7 days of treatment, blood glucose was positively correlated with improved Marshall score and BISAP score (P<0.05). The blood glucose level in patients with decreased blood calcium was higher than that in patients with normal blood calcium (P<0.05). The decrease of blood calcium had positive interaction with the increase of blood glucose (P<0.05). After 3 and 7 days of treatment, the AUC of blood glucose combined with blood calcium was greater than that predicted by single index (P< 0.05). CONCLUSION: Blood glucose and blood calcium are related to the severity of the disease in SAP patients. There is an interaction between blood glucose and blood calcium in predicting the prognosis of SAP patients. The combined detection of blood glucose and blood calcium has a certain predictive effect on the prognosis of SAP patients.
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Background: Acute pancreatitis presents a broad clinical spectrum ranging from cases so mild that symptoms abate before the diagnosis is actively pursued, to cases which progress rapidly to multisystem failure and eventual demise of patient despite current mode of therapy. Aims And Objectives: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis. Materials And Methods: Study design: A prospective longitudinal observational study. Study area: Ramakrishna Mission Seva Pratishthan Hospital, Kolkata. Study period: April 2017 to March 2018 Sample size: 76 patients diagnosed with acute pancreatitis after admission. All patients were subjected to a thorough history taking, clinical examination, routine blood tests and imaging and monitoring of vitals. Patients with complications like sepsis, shock or organ failure was treated in ICU, with invasive and non-invasive monitoring. Thorough IV fluid resuscitation and appropriate analgesics were used with conservative management. Initially put in NPM, started with enteral feeding when ileus subsided or parenteral feeding at appropriate time if clinically unstable. ERCP was done followed by open/laparoscopic cholecystectomy in gallstone pancreatitis patients. Results: The overall mortality for the study group was 11.8 % and the morbidity rate was 31.5 %. The mortality for male was greater than that for female. The mortality for patients over 50 years of age was greater than that of patients below 50 years of age. The mean duration of hospitalization for the total study group was 14 days and it was found to be higher in male (18 days) than for female (10 days). The mortality for this idiopathic group(n=4, 16.67%) was found to be higher than that for the alcoholic group(n=3, 13.6%) and those with biliary tract disease(n=2, 6.67%), whereas morbidity of the alcoholic group(n=12, 40%) was found higher than the idiopathic group(n=8, 33.3%) and biliary disease group(n=4, 18.1%). Mortality rate in patients with pseudocyst was 10%, 50% in pancreatic abscess, 42.8% in circulatory failure patients, 50% in renal failure patients and 75% in respiratory failure patients. Conclusion: Despite earlier recognition and appropriate care the morbidity and mortality rates have remained quite high in cases of severe attack of acute pancreatitis
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Objective:To detect the expression and clinical significance of microRNA-128-3p (miR-128-3p) in the plasma of patients with severe pancreatitis (SAP) .Methods:A total of 175 patients with acute pancreatitis who were treated in our hospital from Jun. 2017 to Dec. 2020 were selected as observation objects. According to the severity of the patients, the patients were divided into 78 cases in mild acute pancreatitis (MAP) group, 50 cases in moderate to severe acute pancreatitis (MSAP) group and 47 cases in severe acute pancreatitis (SAP) group; according to the patient’s prognosis, the SAP group was divided into 28 cases in the survival group and 19 cases in the death group. The level of miR-128-3p was detected by qRT-PCR method, and patients were evaluated with Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and Ranson score, the correlation between plasma miR-128-3p level and APACHEⅡ, Ranson score was analyzed by Pearson, the predictive value of plasma miR-128-3p for poor prognosis of SAP patients was analyzed by ROC curve.Results:There were statistically significant differences in APACHE II[ (3.41±1.56) , (5.63±1.78) , (6.57±1.83) points], Ranson [ (2.58±1.34) , (4.95±1.47) , (6.06±1.92) points] and plasma CRP [ (39.73) ±12.31) , (70.25± 24.38) , (142.51±40.55) mg/L], serum calcium [ (1.95±0.31) , (13.26±5.24) , (14.21±6.32) mmol/L], among the MAP group, MSAP group and SAP group ( P<0.05) ; Compared with the MAP group (1.05±0.12) , the plasma miR-128-3p expression levels in the MSAP group (0.83±0.08) and the SAP group (0.57±0.05) were significantly decreased ( P<0.05) ; compared with the MSAP group (0.83±0.08) Compared with the SAP group (0.57±0.05) , the plasma miR-128-3p expression level was significantly decreased ( P<0.05) ; Compared with the survival group [ (0.65±0.08) , (5.91±1.64) points, (5.45±1.25) points, (120.43±30.56) mg/L], the plasma miR-128-3p of SAP patients in the death group was (0.43±0.05) expression levels were significantly reduced, APACHE II [ (7.43±2.21) points], Ranson score [ (7.22±1.59) points] and plasma CRP level [ (171.52±42.38) mg/L] were significantly increased ( P<0.05) ; the results of correlation analysis showed that plasma miR-128-3p level was negatively correlated with APACHEⅡ and Ranson scores ( r=-0.531, -0.609, P<0.05) ; The diagnostic efficacy of plasma miR-128-3p in predicting poor prognosis of SAP patients is better than APACHEⅡ, Ranson score, and CRP. Conclusion:Plasma miR-128-3p level is elevated in patients with severe pancreatitis, which is of certain value for the diagnosis and prognostic evaluation of SAP.
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Objective:To investigate the protective effect of overexpressed tripartite motif containing (TRIM27) on severe acute pancreatitis (SAP) in mice and its possible mechanism.Methods:Twenty-four mice were randomly divided into the sham operation + control virus group (AAV-GFP group), sham operation + overexpression of TRIM27 group (AAV-TRIM27 group), SAP + control virus group (SAP+AAV-GFP group), SAP + overexpression of TRIM27 group (SAP + AAV-TRIM27 group), with 6 mice in each group. SAP model of mice was established by intraperitoneal injection of L-arginine (4 mg/kg). The sham operation group was injected with equal volume of normal saline, and the virus group was injected with control or TRIM27 overexpression adeno-associated virus (2×10 11 μg/ per mice). The serum and pancreatic tissue samples were collected 72 h after modeling. The levels of serum amylase, lipase, tumor necrosis factor α (TNF-α), interleukin-1b (IL-1b), IL-6, macrophage chemoattractant protein-1 (MCP-1) and the expression of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) in pancreatic tissue were detected by enzyme-linked immunosorbent assay. Hematoxylin eosin staining was used to observe the pathological damage of pancreatic tissue. The expressions of myeloperoxidase (MPO) and Ly6g positive inflammatory cells in mouse pancreas were observed by immunohistochemistry. The expression of p-p65, p65, p-ASK1, ASK1, p-JNK, JNK, p-p38 and p38 in pancreatic tissue were detected by Western blot. Results:The expression of TRIM27 in pancreatic of mice was significantly down regulated after SAP ( P<0.05); after overexpression of TRIM27 by adeno-associated virus, the expression of TRIM27 in mouse pancreas was significantly up-regulated ( P<0.05). There was no significant difference in the indexes of mice between the AAV-GFP group and AAV-TRIM27 group ( P>0.05). Compared with the SAP + AAV-GFP group, the levels of serum amylase, lipase, TNF-α, IL-1b, IL-6 and MCP-1 in mice of the SAP + AAV-TRIM27 group were significantly decreased, MDA in pancreatic tissue was decreased, SOD and GSH were increased, MPO and Ly6g inflammatory cells were significantly decreased, and p-p65, p-ASK1, p-JNK, and p-p38 protein expression were down regulated. Conclusions:Overexpression of TRIM27 alleviates SAP in mice by inhibiting inflammatory response and oxidative stress, and its mechanism may be through inhibiting NFκB/MAPK signaling pathway.
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Objective:To investigate the risk factors for moderate to severe pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP) .Methods:Data of 6 731 patients diagnosed as having biliary and pancreatic diseases with initial papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) from June 2010 to June 2020 in the First Affiliated Hospital of Air Force Medical University were retrospectively analyzed. Parameters related to intubation and postoperative complications were prospectively collected. The main end point was moderate to severe PEP. Logistic regression analysis was used to explore the risk factors for moderate to severe PEP.Results:The incidence of overall PEP and moderate to severe PEP in 6 731 ERCP patients with initial papilla were 5.3% ( n=359) and 1.0% ( n=68) respectively. Univariate analysis showed that female, indications of ERCP, cannulation method, cannulation time, cannulation attempts, times of inadvertent pancreatic duct cannulation and cannulation with or without trainee involvement were all associated with moderate to severe PEP ( P<0.10). Multivariate analysis showed that female ( OR=2.32, 95% CI:1.28-4.21, P=0.006), non-common bile duct stones indication ( OR=2.04, 95% CI:1.16-3.59, P=0.014), cannulation time ≥5 min ( OR=2.23, 95% CI: 1.20-4.13, P=0.011), inadvertent pancreatic duct cannulation time ≥1 ( OR=1.88, 95% CI: 1.03-3.44, P=0.040) and non-trainee involvement cannulation ( OR=1.81, 95% CI: 1.02-3.22, P=0.043) were independent risk factors for moderate to severe PEP. Conclusion:The independent risk factors for moderate to severe PEP include female, non-common bile duct stones indication, non-trainee involvement cannulation and difficult cannulation. Great importance should be attached to these factors above during the whole perioperative period of ERCP.
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Objective:To study the clinical effect of different doses of ulinastatin combined with glutamine in treatment of acute severe pancreatitis.Methods:70 patients with acute severe pancreatitis patients admitted in our hospital from Jan. 2017 to Oct. 2019 were enrolled. According to the different dosage of ulinastatin, these patients were divided into 200 000 IU ulinastatin combined with glutamine group (200 000 IU combination group) , 400 000 IU ulinastatin combined with glutamine group (400000 IU combination group) , and 600 000 IU ulinastatin combined with glutamine group (600 000 IU combination group) . The study compared the 1-week mortality rate, abdominal pain relief time, respiratory frequency and heart rate back to normal time, blood amylase, glucose, C-reactive protein, procalcitonin levels, and white blood cell (WBC) count among the different groups.Results:The mortality of 400 000 IU combined group and 600 000 IU combined group were 4.35% and 5.56% respectively, which were significantly lower than 31.58% and 35% of the control group and 200 000 IU combined group ( P< 0.05) . The time of abdominal pain relief, respiratory rate and heart rate returning to normal in the 400 000 IU combined group were (7.21±1.25) d, (8.54±1.83) d and (9.54±2.23) d respectively, and (7.52±1.83) d, (8.13±1.75) d and (9.37±2.31) d in the 600 000 IU combined group, which were significantly lower than (9.12±2.78) d, (9.85± 3.16) d and (10.86±2.68) d in the control group and (8.76±1.96) d, (8.76±1.96) d and (10.62±1.43) d in the 200 000 IU combined group ( P<0.05) , There was no significant difference between the control group and the 200 000 IU combination group ( P>0.05) . Compared with the control group, there were significant differences in blood glucose, CRP and leukocyte count in different doses of ulinastatin+ glutamine treatment group ( P<0.05) ; However, there was no significant difference in blood glucose and CRP levels between different doses of ulinastatin+ glutamine treatment group ( P>0.05) , but compared with 200 000 IU combination group and 400 000 IU combination group, the leukocyte level of 600 000 combination group was significantly higher ( P<0.05) . Conclusion:ulinastatin combined with glutamine can significantly improve the clinical prognosis of patients with severe acute pancreatitis, but the clinical effect varies with the dose of ulinastatin. Conclusion Ulinastatin combined with glutamine can significantly improve the clinical prognosis of patients with acute severe pancreatitis, but the clinical effect varies with the dose of ulinastatin.
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Objective To investigate the effects of continuous renal replacement therapy (CRRT) on biochemical and physiological indexes of severe acute pancreatitis (SAP) and its clinical efficacy.Methods Totally 98 patients with severe acute pancreatitis admitted in our hospital were divided into experimental group(n=49) and control group(n=49).The experimental group received CRRT and the control group did not receive.Heart rate,body temperature,blood routine,urine output,mean arterial pressure,liver function,blood biochemistry and arterial blood gas analysis before and after treatment in the two groups were measured and compared before and after treatment.Results In the experimental group,respiration,heart rate,oxygen partial pressure (PO2),carbon dioxide partial pressure (PCO2),alkali residual (BE) and pH were significantly improved at 12 h after treatment,and lasted until 36 h after treatment;the differences were statistically significant (P＜0.05).In the experimental group,blood calcium increased,creatinine,urea nitrogen and blood sugar level decreased significantly,blood potassium and blood sodium level were stable within 12 h after treatment,and the difference was statistically significant,compared with the control group (P＜0.05).In the experimental group,the alanine aminotransferase (ALT) decreased significantly after 36 h of treatment,and the difference was statistically significant(P＜0.05).There was a significant difference between the experimental group and the control group in the hematocrit (HTC) and white blood cell count (WBC) before treatment (P＜ 0.05).The platelet count (PLT) in the experimental group decreased within 12 h,and the difference was statistically significant before treatment(P＜0.05).Conclusion Compared with the conventional treatment,the therapeutic effect of CRRT on SAP is more significant.The improvement of the physiological and biochemical indexes of the patients is obvious,which is of great significance to the prognosis of the patients.
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Objective To investigate the effect of early enteral nutrition suspension nutritional support combined with somatostatin on serum procalcitonin (PCT), prealbumin (PA), transferrin (TF) and amylase (AMY) in ICU patients with severe acute pancreatitis. Methods From July 2014-November 2016, 66 cases of ICU severe pancreatitis in Beijing Tongren Hospital were divided into control group and treatment group according to treatment plan, 33 cases each group. The control group was given early parenteral nutrition support + somatostatin treatment, The treatment group was given early enteral nutrition suspension nutrition support + somatostatin treatment. Complications of the tw groups were compared, prognostic score (APACHEII, SOFA and modified Marshall scores), serum PCT, PA, TF, AMY levels and serum-related inflammatory factors [interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor - α (TNF-α) ]before and after treatment were compared. Results There was no significant difference in APACHEII, SOFA and modified Marshall scores between the two groups before treatment (P ＞ 0. 05). Compared with the control group after treatment, the APACHEII, SOFA and modified Marshall scores of the treatment group were lower than those of the control group (P ＜ 0. 05). There was no significant difference in serum PCT, PA, TF and AMY between the two groups before treatment (P ＞ 0. 05). Compared with the control group after treatment, the levels of serum PCT and AMY in the treatment group were lower than those in the control group, and the levels of serum PA and TF were higher (P ＜ 0. 05). There was no significant difference in serum TNF-α, IL-6 and IL-10 levels between the two groups before treatment (P ＞ 0. 05). Compared with the control group after treatment, the levels of serum TNF-α and IL-6 in the treatment group were lower than those in the control group, and the serum IL-10 level was higher (P ＜ 0. 05). The incidence of complications in the treatment group was 15. 15％ (5 /33) lower than that in the control group (42. 42％, 14 /33), the difference was statisti- cally significant (P ＜ 0. 05). Conclusion Early stage enteral nutrition suspension nutrition support combined with somatostatin in the treatment of ICU severe pancreatitis patients can effectively improve serum levels of PA, TF and IL-10, reduce PCT, AMY, TNF-α, IL-6 levels, improve the prognosis, and its security is high.
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Objective To investigate prognosis and related factors of infectious pancreatic necrosis(IPN) caused by multidrug-resistant organisms(MDROs).Methods Clinical data of 53 IPN patients admitted to a hospital between October 2010 and March 2016 were analyzed retrospectively,patients were divided into MDRO infection group and common bacterial infection group according to antimicrobial resistance of pathogens isolated from peripancreatic drainge fluid,prognosis and related factors of two groups were compared.Results Among 53 IPN patients with confirmed evidence for pathogenicity,33(62.3％)were in MDRO infection group,and 20(37.7％)were in common bacterial infection group,the most common MDROs isolated from peripancreatic drainage was multidrug-resistant Acinetobacter baumannii (MDRO-AB) (37.5％,18/48).The mortality of IPN patients was 30.2％ (16/53),mortality of MDRO infection group was higher than common bacterial infection group(39.4％ [13/33] vs 15.0％ [3/ 20],P＜0.05);the severity score,length of intensive care unit (ICU) stay,and hospitalization expenses in MDRO infection group were all higher than common bacterial infection group(all P＜0.05).The mortality of IPN patients were closely associated with MDRO infection and severity score of acute pancreatitis (all P ＜ 0.05).Conclusion Prognosis of patients with MDRO infection is poor,treatment is difficult,MDRO infection has become one of the most important challenge to the treatment of severe acute pancreatitis.
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OBJECTIVE:To observe clinical efficacy and safety of Xuebijing injection combined with octreotide and ulinastatin in the treatment of acute severe pancreatitis.METHODS:A total of 150 patients with acute severe pancreatitis admitted to emergency department of our hospital during Jan.2012-Jan.2016 were divided into control group,drug control group and observation group according to therapy method,with 50 cases in each group.All patients were treated with fasting,gastrointestinal decompression time,antibiotics,blood purification and other conventional treatment.Control group additionally received Cctreotide acetate injection 0.1 mg intravenously,tid,on the basis of conventional treatment.Drug control group additionally received Ulinastatin for injection 100 000 U added into 10％ Glucose injection 250 mL,ivgtt,bid,on the basis of control group.Observation group additionally received Xuebijing injection 100 mL added into 10％ Glucose injection 100 mL,ivgtt,bid,on the basis of drug control group.Three groups were treated for 10 days.The clinical indexes as fotal response rates,gastrointestinal decompression time,abdominal pain relief time,length of stay were observed in 3 groups.Related serum indexes (AMY,WBC,IL-6,CRP,TNF-α) before and after treatment and the occurrence of compliance during treatment were compared among 3 groups.RESULTS:The total response rate of observation group was 90.0％,which was significantly higher than 72.0％ of drug control group and 52.0％ of control group,with statistical significance (P＜0.05).The gastrointestinal decompression time,abdominal pain relief time and length of stay in observation group were significantly shorter than drug control group and control group,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in the serum levels of AMY,WBC,IL-6,CRP or TNF-α among 3 groups (P＞0.05).After treatment,above serum indexes of 3 groups were decreased significantly,and observation group was significantly lower than the drug control group and control group,with statistical significance (P＜0.05).The incidence of ARDS,shock and acute renal failure in observation group were significantly lower than drug control group and control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of sepsis,abdominal abscess or MODS among 3 groups (P＞0.05).CONCLUSIONS:Xuebijing injection combined with octreotide and ulinastatin show significant therapeutic efficacy for acute severe pancreatitis,can effectively control inflammation progress,improve clinical symptoms and promote disease recovery with good safety.
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Objective:To explore the effect and nursing measures of parenteral nutrition support treatment and nasal jejunum nutrition support treatment in patients with acute severe pancreatitis.Method:85 cases of acute severe pancreatitis were divided into the study group and the control group.The patients in the control group were given routine parenteral nutrition support therapy and clinical nursing.The patients in the study group were treated with nasal jejunum tube for enteral nutrition support,and the corresponding clinical nursing intervention was given during the treatment.The clinical indexes of two groups were compared and analyzed.Result:Before treatment,there were no significant difference in serum CRP,ALB,TP levels between the two groups (P ＞ 0.05).After nutritional treatment and clinical nursing,the above indexes of the two groups were improved,but the indexes of the study group improved significantly more than the control group (P ＜ 0.05).The BMI index in the study group was not significantly different compared with the control group (P ＞ 0.05).In the study group,the first time of get out of bed,mechanical ventilation time,abdominal distension remission time,sserum amylase and urine amylase recovery time were significantly lower than those of the control group (P ＜ 0.05).The incidence of complications including abdominal distension,diarrhea,nausea and vomiting,upper gastrointestinal bleeding in the study group were significantly lower than those in the control group (P ＜ 0.05).Conclusion:nasal jejunum nutrition support treatment can not only play a vital role in treatment of acute severe pancreatitis patients with malnutrition,but also protect the patient gastrointestinal tract.The individualized nursing intervention can effectively reduce the incidence of complications and ensure the successful implementation of enteral nutrition.
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Objective:To study the clinical effect of blood purification and sustained glucocorticoid therapy on severe pancreatitis with respiratory distress syndrome,for providing clinical reference for such concomitant diseases.Methods:A total of 132 patients from April 2012 to June 2014in our hospital with severe pancreatitis and respiratory distress syndrome were studied,they were randomly divided into two groups,patients in the two groups were given conventional anti-infective,gastrointestinal decompression,rehydration therapy and other infrastructure,the control group were treated with continuous blood purification treatment,the observation group were treated with continuous blood purification and high-dose dexamethasone,the clinical symptoms,laboratory indicator in time,the levels of inflammatory cytokines,the APACHE Ⅱ scores and MODS scores and survival were compared.Results:The time of abdominal distention disappeared,blood amylase,urine amylase and pancreatic edema improvement in observation group was significantly improved than the control (P＜0.05);when compared with before,the CRP,IL-6,IL-8 and TNF-α of two groups were significantly decreased,and the index in observation group decreased more significantly,the difference was statistically significant (P＜0.05);when compared with before,the score of APACHE Ⅱ and MODS were significantly lower than control,the difference was statistically significant(P＜0.05);The final survival rate in observation group was 90.8％,which significantly higher than 61.5％ in control,the difference was statistically significant(P＜0.05).Conclusion:The effect of continuous blood purification combined with glucocorticoids (eg dexamethasone) in patients with severe pancreatitis and respiratory distress syndrome is remarkable,the clinical symptoms can significantly improved,the levels of inflammatory factors,effective recovery laboratory indicators,APACHE Ⅱ score and MODS score were decreased,the survival was higher,it was worthy of clinical use.
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Objective To research the efficacy of alprostadil injection combined the octreotide for acute severe pancreatitis and influence on the serum levels of tumor necrosis factor-α(TNF-α),interleukin-6,interleukin-18,occludin.Method 68 cases of patients with acute severe pancreatitis from September 2013 to February 2017 in our hospital,according to the treatment method group,34 cases in each group,control group treatmented by octreotide,the research group based on the control group treatmented by alprostadil injection,both groups was treated for five days.Clinical curative effect,alleviate clinical symptoms time,TNF-α,IL-6,IL-18,occludin,and adverse reactions occur was compared between two groups.Results The total effective rate of research group was higher than the control group(97.07％vs.79.41％,P<0.05).Bowel sounds,stomach ache,body temperature and serum amylase remission time of research group was shorter than control group(P<0.05).TNF-α,IL-6,IL-18 of research group was lower than the control group(P<0.05),the occludin of research group was higher than the control group(P<0.05).The adverse reactions was no differences between the two groups.Conclusion The exact effect of alprostadil injection combined the octreotide for acute severe pancreatitis,improve serum levels of TNF-α,IL-6,IL-18,occludin.
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Objective To compare the efficacy in patients with severe pancreatitis treated by minimally invasive surgery and open surgery. Methods Seventy-three cases of patients with severe pancreatitis which were treated in our hospital between June 2011 and June 2015 were divided into group A (n = 37) and group B(n =36). Group A were treated by minimally invasive surgery while group B by open surgery. The perioperative stress reactions , postoperative inflammatory reactions , incidence of complications and mortality were compared between the two groups. Results The proportion of patients with perioperative (0+1) level pain in group A (70.3%) was significantly higher than that in group B (44.4%) (P < 0.05). Seventy-two hours after surgery, the CRP, TNF-α and IL-6 in group A were lower than those before surgery and those in group B while APN in group A was higher than that before surgery and that in group B (P < 0.05). The incidence of pulmonary infection and mortality in group A (27.0%, 5.4%) were lower than those in group B (50.0%, 22.2%) (P < 0.05). Conclusions Minimally invasive surgery in the treatment of severe pancreatitis has slight trauma. The postoperative pain is mild and complications are fewer , and the mortality is low.
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Objective:To investigate the essential biochemical indices like 1α-hydroxylase and hypocalcaemia in the rats with severe acute pancreatitis and explore the correlation between them.Methods:A total of 120 SPF grade Wistar male rats which were in similar physiological status were selected and randomly divided into two groups: sham group (SO group) and severe acute pancreatitis group (SAP group). Then they were divided into 1 h, 3 h, 6 h, and 12 h subgroups according to the killing time. The severe acute pancreatitis model was established by retrograde injection of 5% sodium taurocholate. Serum calcium, serum creatinine, serum urea nitrogen and serum amylase were measured at different time. Serum 1, 25 dihydroxy vitamin D3 level was determined by enzyme linked immunosorbentassay. The expression of 1α-hydroxylase protein in the kidney tissue was determined with Western blotting and immunohistochemistry to observe its location. The pathologic features of the kidney tissue section was observed under light microscope and submicroscopic structure of the proximal convoluted tubule epithelial cell was observed under transmission electron microscope. Results:Compared with the SO group, rats in the SAP group showed continuous pathological injury as time went by. There was significant increase in serum creatinine, serum urea nitrogen and serum amylase in SAP group compared with the SO group 1, 3,6,12 hours after the operation (P<0.05). There was significant decrease in serum calcium and 1, 25 dihydroxy vitamin D3 3,6,12 hours after the operation (P<0.05). It also showed that the expression of the 1α-hydroxylase protein in kidney tissues was upregulated at 1 h, 3 h and decreased at 6 h,12 h compared with the SO group. The serum calcium, 1, 25 dihydroxy vitamin D3 and the expression of the 1α-hydroxylase protein in kidney tissues of the SAP group showed sustaining decrease. Western blotting showed positive correlation between the 1α-hydroxylase expression and serum calcium at 3 h, 6 h and 12 h (r=0.976,P<0.001;r=0.948,P<0.001; r=0.742, P=0.001) and also positive correlation between the 1α-hydroxylase expression and serum 1, 25 dihydroxy vitamin D3 at 1 h,3 h, 6 h and 12 h (r=0.935,P<0.001;r=0.952,P<0.001;r=0.917,P<0.001; r=0.874, P<0.001).Conclusions:At the early stage of the kidney injury, the expression of 1α-hydroxylase in the kidney tissue is reduced with the progress of the disease and the decrease in its activity has a correlation with the hypocalcaemia.
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Objective To investigate the correlation between prognosis of patients with severe acute pancreatitis and changes of plasma albumin. Methods A total of 235 patients with severe pancreatitis who were admitted into hospital from September 2008 to October 2013 were selected as research object. According to the prognosis, they were divided into the survival group (143 cases who were recovered and still alive) and the death group (92 cases who died of the deterioration of diseases). Retrospectively analyzed the basic situation of the pa-tients and the changes of serum albumin levels in the two groups. And the correlation between prognosis of patients with severe acute pancrea-titis and changes of plasma albumin were evaluated by the logistic regression analysis. Results Compared with the death group,there were significant differences (P<0. 05) in terms of age,APCHEⅡ score,Ranson score,SOFA score,length of hospital stay,duration of mechani-cal ventilation,continuous renal replacement therapy,average serum albumin level,decrease of serum albumin within 24 hours,and variation of serum albumin. And ROC curves suggested the best cutoff value of decrease of serum albumin within 24 hours to predict death in patients within 24 hours was 4. 24 g/L,and the best cutoff value of variation of serum albumin to predict death was 13. 6%. Logistic regression analy-sis showed that the major risk factors of death in severe acute pancreatitis were decrease of serum albumin within 24 hours,variation of serum albumin within 24 hours,average serum albumin level,and the APCHEⅡscore. Conclusion Changes in plasma albumin can reflect the se-verity of severe acute pancreatitis,and the sharp decrease of serum albumin within 24 hours can be used as a risk factor for death.
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Objective: To investigate the essential biochemical indices like 1 -hydroxylase and hypocalcaemia in the rats with severe acute pancreatitis and explore the correlation between them. Methods: A total of 120 SPF grade Wistar male rats which were in similar physiological status were selected and randomly divided into two groups: sham group (SO group) and severe acute pancreatitis group (SAP group). Then they were divided into 1 h, 3 h, 6 h, and 12 h subgroups according to the killing time. The severe acute pancreatitis model was established by retrograde injection of 5% sodium taurocholate. Serum calcium, serum creatinine, serum urea nitrogen and serum amylase were measured at different time. Serum 1, 25 dihydroxy vitamin D3 level was determined by enzyme linked immunosorbentassay. The expression of 1-hydroxylase protein in the kidney tissue was determined with Western blotting and immunohistochemistry to observe its location. The pathologic features of the kidney tissue section was observed under light microscope and submicroscopic structure of the proximal convoluted tubule epithelial cell was observed under transmission electron microscope. Results: Compared with the SO group, rats in the SAP group showed continuous pathological injury as time went by. There was significant increase in serum creatinine, serum urea nitrogen and serum amylase in SAP group compared with the SO group 1, 3, 6, 12 hours after the operation (P<0.05). There was significant decrease in serum calcium and 1, 25 dihydroxy vitamin D3 3, 6, 12 hours after the operation (P<0.05). It also showed that the expression of the 1-hydroxylase protein in kidney tissues was upregulated at 1 h, 3 h and decreased at 6 h, 12 h compared with the SO group. The serum calcium, 1, 25 dihydroxy vitamin D3 and the expression of the 1-hydroxylase protein in kidney tissues of the SAP group showed sustaining decrease. Western blotting showed positive correlation between the 1-hydroxylase expression and serum calcium at 3 h, 6 h and 12 h (r=0.976, P<0.001; r=0.948, P<0.001; r=0.742, P=0.001) and also positive correlation between the 1-hydroxylase expression and serum 1, 25 dihydroxy vitamin D3 at 1 h, 3 h, 6 h and 12 h (r=0.935, P<0.001; r=0.952, P<0.001; r=0.917, P<0.001; r=0.874, P<0.001). Conclusions: At the early stage of the kidney injury, the expression of 1-hydroxylase in the kidney tissue is reduced with the progress of the disease and the decrease in its activity has a correlation with the hypocalcaemia.
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OBJECTIVE@#To investigate the essential biochemical indices like 1 -hydroxylase and hypocalcaemia in the rats with severe acute pancreatitis and explore the correlation between them.@*METHODS@#A total of 120 SPF grade Wistar male rats which were in similar physiological status were selected and randomly divided into two groups: sham group (SO group) and severe acute pancreatitis group (SAP group). Then they were divided into 1 h, 3 h, 6 h, and 12 h subgroups according to the killing time. The severe acute pancreatitis model was established by retrograde injection of 5% sodium taurocholate. Serum calcium, serum creatinine, serum urea nitrogen and serum amylase were measured at different time. Serum 1, 25 dihydroxy vitamin D3 level was determined by enzyme linked immunosorbentassay. The expression of 1-hydroxylase protein in the kidney tissue was determined with Western blotting and immunohistochemistry to observe its location. The pathologic features of the kidney tissue section was observed under light microscope and submicroscopic structure of the proximal convoluted tubule epithelial cell was observed under transmission electron microscope.@*RESULTS@#Compared with the SO group, rats in the SAP group showed continuous pathological injury as time went by. There was significant increase in serum creatinine, serum urea nitrogen and serum amylase in SAP group compared with the SO group 1, 3, 6, 12 hours after the operation (P<0.05). There was significant decrease in serum calcium and 1, 25 dihydroxy vitamin D3 3, 6, 12 hours after the operation (P<0.05). It also showed that the expression of the 1-hydroxylase protein in kidney tissues was upregulated at 1 h, 3 h and decreased at 6 h, 12 h compared with the SO group. The serum calcium, 1, 25 dihydroxy vitamin D3 and the expression of the 1-hydroxylase protein in kidney tissues of the SAP group showed sustaining decrease. Western blotting showed positive correlation between the 1-hydroxylase expression and serum calcium at 3 h, 6 h and 12 h (r=0.976, P<0.001; r=0.948, P<0.001; r=0.742, P=0.001) and also positive correlation between the 1-hydroxylase expression and serum 1, 25 dihydroxy vitamin D3 at 1 h, 3 h, 6 h and 12 h (r=0.935, P<0.001; r=0.952, P<0.001; r=0.917, P<0.001; r=0.874, P<0.001).@*CONCLUSIONS@#At the early stage of the kidney injury, the expression of 1-hydroxylase in the kidney tissue is reduced with the progress of the disease and the decrease in its activity has a correlation with the hypocalcaemia.
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Objective:To observe the clinical effect of ulinastatin combined with somatostatin in the treatment of acute severe pan-creatitis. Methods:Totally 130 cases of severe acute pancreatitis patients were randomly divided into two groups with 65 cases in each. The control group was given the routine treatment and 3mg somatostatin in 250ml sodium chloride injections, ivd, bid, and the treatment group was given 10ku ulinastatin in 250ml sodium chloride injections additionally, ivd, bid. After the 10-day treatment, the clinical symptom disappearance time, the recovery time of respiratory and heart rate, length of stay, blood and urine amylase, and clin-ical total effective rate were compared between the two groups. Results:The symptom disappearance time, recovery time of respiratory and heart rate and length of stay in the treatment group were all shorter than those in the control group (P0. 05). The total effective rate of the treatment group was 95. 38%, while that of the control group was 73. 84% with significant difference (P<0. 05). Conclusion:The application of ulinastatin in the treatment of severe acute pancreatitis shows obviously curative effect, which can effectively improve the clinical symptoms and shorten the course of disease, and is valuable in clinical use.