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Objective:To investigate the efficacy of early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of severe acute pancreatitis (SAP) .Methods:170 SAP patients admitted to Quzhou People’s Hospital from Jan. 2016 to Jun. 2020 were divided into the observation group and the control group, with 85 cases in each group, according to the random number table method. The control group received comprehensive medical treatment, while the observation group received early minimally invasive catheterization continuous abdominal lavage and drainage intervention based on the control group. The efficacy and complications after 1 week of treatment were evaluated. Besides, the intra-abdominal pressure (IAP) and acute physiology and chronic health II (APACHEII) were scored, liver and lung function indexes [oxygenation indexes, oxygen partial pressure (PaO 2) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) ], and inflammation indexes [C-reactive protein (CRP) , tumor necrosis factor-α (TNF-α) , macrophage inflammatory protein-1α (MIP-1α) ] were measured before and 1 week after the treatment. Results:The total effective rate of the treatment in the observation group was 91.77%, which was significantly higher than 77.65% in the control group ( P<0.05) . The level of IAP, APACHEII score, AST, ALT, CRP, TNF-α, MIP-1α of the two groups after 1 week of treatment decreased significantly compared with those before treatment, while the oxygenation index and PaO 2 increased significantly. The levels of IAP, APACHEII score, AST, ALT, CRP, TNF-α, and MIP-1α in the observation group were lower than those in the control group after 1 week of treatment, while the oxygenation index and PaO 2 in the observation group were higher than those in the control group, with statistically significant difference ( P<0.05) . The incidence rates of multiple organ dysfunction syndrome (MODS) , sepsis and systemic inflammatory response syndrome (SIRS) in the observation group were: 8.24%, 11.76% and 15.29%, significantly lower than 21.18%, 29.41% and 30.59% in the control group ( P<0.05) . Conclusion:Early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of SAP is safe and effective, which can significantly inhibit pro-inflammatory factors, and protect liver and lung function.
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Objective To investigate the role of p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in hypocaleaemia and parathyroid hormone receptor 1 ( PTHR1 ) of rats with acute necrotizing pancreatitis (ANP).Methods Seventy-two male health adult Spragne-Dawley rats were randomized into three groups:ANP group,ANP treated with SB203580 group (SB group),sham operation group (SO group).Every group was sub-divided into 3,6,12 h group with 8 rats in each one.ANP model was induced by retrograde infusion with 5% sodium taurocholate solution into the biliopancreatie duct.In the SB group,rats were treated with the specific p38MAPK inhibitor:SB203580 30 minutes before the induction of ANP model.The serum level of calcium was determined,the change of phosphorylated p38MAPK and TNFalpha were measured by western blot and the expression of PTHR1 mRNA was determined by quantitative real time RT-PCR.Results 6 h after ANP model induction,the serum levels of calcium in ANP,SB and SO group were (2.50±0.08 ) mmol/L,(2.11±0.06 ) mmol/L and (2.35±0.10 ) mmol/L,respectively;the expression levels of pbosphorylated p38MAPK in bone tissue were 0.14±0.04,0.80±0.06 and 0.33±0.05,respectively;the expression levels of p38MAPK TNF-alpha were 0,0.91±0.04 and 0.44±0.03,respectively;the expression levels of PTHR1 mRNA were 1.00±0.12,0.23±0.04 and 0.44±0.06,respectively.The expression levels of p38MAPK and TNF-α in SB group were significantly lower than those in the ANP group (P ＜ 0.01 );while the expression levels of PTHR1 mRNA and calcium were significantly higher than those in the ANP group (P ＜0.01 ).Conclusions P38MAPK signal transduction pathway may mediate the development of hypocaleaemia in the course of ANP,and hypoealcaemia could be improved by blocking this pathway.
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Objective To investigate the effects of methylprednisolone on neurocyte apoptosis in rats with severe acute pancreatitis(SAP).Methods Thirty-six SD rats were divided into sham operation group,SAP group and methylprednisolone group(12 rats in each group).SAP model was constructed by injecting 5%sodium taurodeoxycholate into biliary-pancreatic duct.Serum amylase,interleukin-6(IL-6),tumor necrosis factor α (TNF-α),volume of aseites and histopathological changes of pancreas were determined.The mRNA expressions of Bcl-2 and Bax in brain tissue were analyzed by RT-PCR.and neuroeyte apoptosis was detected by TUNEL method.Results The levels of serum IL-6 and TNF-α were significantly increased:the expression of Bcl-2 mRNA in brain tissue was down-regulated;the expression of Bax mRNA was up-regulated;the Bcl-2/Bax ratio Was decreased:the apoptosis of the neurocytes was increased in SAP group.Compared with SAP group,the levels of serum IL-6 and TNF-α were significantly decreased;the expression of Bcl-2 mRNA was unchanged but the expression of Bax mRNA was down-regulated in brain tissue,so the Bcl-2/Bax ratio was elevated significantly;the rate of the ueurocyte apoptosis in brain tissue were reduced in methylprednisolone group.Conclusions The apoptosis of neurocytes in brain tissue may be one of the factors causing pancreatic encephalopathy.Methylprednisoione can inhibit the release of IL-6 and TNF-α.improve the balance of Bcl-2 and Bax expression and decrease the apoptosis of neurocytes in brain tissue.