acute pancreatitis management update：急性胰腺炎的更新管理

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1、AcutePancreatitis:ManagementUpdateJamieS.Barkin,M.D.,MACP,MACG,AGAF,FASGEProfessorofMedicineUniversityofMiami,MillerSchoolofMedicineChief,DivisionofGastroenterologyMountSinaiMedicalCenterOverviewofAcutePancreatitis85%ofpatientshaveinterstitialpancreati

2、tis;15(range4–47%)havenecrotizingpancreatitisAmongpatientswithnecrotizingpancreatitis,33%(range16-47%)haveinfectednecrosisApproximately10%ofpatientswithinterstitialpancreatitisexperienceorganfailure,butinthemajorityitistransientMortalityinacutepancreat

3、itisoverall,isapproximately5%:3%ininterstitialpancreatitis,17%innecrotizingpancreatitisInnecrotizingpancreatitis,mortality3-foldinfectedvs.sterilenecrosisMortalityincreaseswithdevelopmentoforganfailure~3%(0-8%)andwithmulti-systemorganfailure47%(range28

4、-69)ACGPracticeGuidelinesinAcutePancreatitisAmJGastroenterol2006;101:2379-2400AcutePancreatitis:Concepts20091)Volumereplacementisthefoundationoftherapy2)EstablishseverityUtilizeinitiallaboratorydatastandardizedmodalitiesi.e.Ransoncriteriarequire48hrsCT

5、abnormalitiescorrelatewithseverityNoneedforearlyCTtoestablishseverity3)EstablishetiologyImportanceistopreventrecurrence4)BiliaryPancreatitisUtilizelaboratorymarkersfordiagnosisofretainedCBDERCPisonlyfortreatingpatientswithcholangitis5)Donotuseprophylac

6、ticantibiotics6)CTguidedaspirationisthediagnostictestforpancreaticinfection&allowsdirectedantibiotictherapyAcutePancreatitis:Concepts2009AcutePancreatitis:Concepts2009(Cont)7)Surgicalinterventioninpatientswithinfectedpancreaticnecrosisbutrarelyinsteril

7、enecrosis8)Earlyenteralfeedingissafe,preventsleakygutandisassociatedwithlesscomplicationsthanTPNDefinitionofSevereAcutePancreatitis(SAP)SAPisacutepancreatitiswithlocaland/orsystemiccomplicationsLocalcomplicationsare:necrotizingpancreatitisInfectednecro

8、sisPancreaticabscessPeripancreaticfluidcollectionandpseudocysticlesionsSystemiccomplicationsare:PulmonaryandrenalfailureShockCardio-circulatorydysfunctionssystemicsepsiscoagulationdisorderBradleyEL,III.ArchSurg1993;128:585-590AcutePancr