Résumé
Objective To develop an integrated standard operation procedure (SOP) for in-hospital emergency care of severe acute pancreatitis (SAP), and to explore the clinical application value. Methods We designed an integrated SOP for in-hospital emergency care of SAP by consulting some experts from emergency intensive care unit (ICU) quality control centers in Shanghai, referencing relevant literature and SAP guidelines at home and abroad, and considering the clinical practice and the experience gained in the integration of “emergency-ICU” contraction at Changzheng Hospital of Navy Medical University (Second Military Medical University). Forty-two SAP patients meeting the SOP criteria, who were admitted to Department of Emergency of Changzheng Hospital of Navy Medical University (Second Military Medical University) between Jul. 2015 and Jan. 2017, were included and set as optimization group. Forty SAP patients, who were admitted to the Department of Emergency between Jan. 2014 and Jun. 2015, were set as routine group. Clinical data of the patients were compared between the two groups, including treatment efficiency, white blood cell count, neutrophil ratio, C-reactive protein level, procalcitonin level, blood amylase level, blood glucose level, blood lactic acid level, serum creatinine level, oxygenation index, modified CT severity index (MCTSI) score, intra-abdominal pressure, urinary neutrophil gelatinase-associated lipocalin (NGAL) level and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 72 h and 1 week after admission, complications and survival. Results The proposed SOP mainly referred to the international standard for diagnosis and treatment of SAP in 2012. The updates were mainly in the emergency first visit and comprehensive treatment scheme. In the former, the emergency surgery doctor was changed to emergency green channel (resuscitation room). In the latter, several clinical protocols were added, such as intrarenous injection of a large dose of ulinastatin, rapid infusion of human albumin (intravenous injection of furosemidum when necessary), standardized full-thatch mirabilite external application and coloclysis of sterile solution of rheum officinale. Compared with the routine group, the total rate of treatment efficiency was significantly better, and hospital stay, exhaust recovery time, bloating relief time, ICU duration time, and continuous renal replacement therapy time were significantly shorter in the optimization group (all P0.05). There were significant differences in the white blood cell count, neutrophil ratio, oxygenation index, MCTSI score and intra-abdominal pressure and the levels of C-reactive protein, procalcitonin, blood glucose, lactic acid, serum creatinine, urinary NGAL on 72 h and 1 week after admission between the two groups (all P0.05). The levels of blood amylase were significantly different between the two groups on 72 h after admission (P0.01). The incidences of acute renal failure, acute respiratory distress syndrome, ascites, abdominal compartment syndrome, pancreatic pseudocyst and pancreatic abscess were significantly lower in the optimization group than those in the routine group (all P0.05). Compared with the routine group, the survival time was significantly longer and the survival rate within two months was significantly higher in optimization group (P0.05). Conclusion The proposed in-hospital integrated emergency SOP can standardize the diagnosis and treatment process of SAP, improve the efficiency of treatment, and reduce mortality of patients.