重症急性胰腺炎合并多脏器功能障碍综合征的非手术治疗

Effects of programed emergency care in patients with severe acute pancreatitis

AIM: To evaluate the effects of programed emergency care in patients with severe acute pancreatitis.

METHODS: Fifty-eight patients with severe acute pancreatitis treated from January 2013 to December 2013 at our hospital were included in an observation group to implement programed emergency care, and 55 patients with severe acute pancreatitis treated from January 2012 to December 2012 at our hospital were included in a control group to receive routine emergency care. The length of hospital stay after intervention, satisfaction to nursing care, Karnofsky performance status (KPS) and Spitzer quality of life score were compared for the two groups.

RESULTS: In the observation group, 39 (67.2%) cases were very satisfied, 18 (31.0%) satisfied, and 1 (1.7%) not satisfied with the nursing care. The corresponding figures in the control group were 23 (41.8%), 25 (45.5%), and 7 (12.7%), respectively. There were significant differences between the two groups (P < 0.05). The length of hospital stay was significantly shorter in the observation group than in the control group (15.4 d ± 2.2 d vs 21.4 d ± 4.6 d, P < 0.01). KPS score was significantly higher in the observation group (76.9 ± 14.3 vs 61.4 ± 10.2, P < 0.01), and the scores of all dimensions of the quality of life scale were significantly higher in the observation group (P < 0.01).

CONCLUSION: Implementation of programed emergency nursing care in patients with severe acute pancreatitis can significantly reduce hospital stay and improve patient's satisfaction to nursing work, patient's health status, and quality of life.

Clinical effect of CT-guided percutaneous catheter drainage versus laparotomy in treatment of infective pancreatic necrosis

AIM: To compare the clinical effect of CT-guided percutaneous catheter drainage versus laparotomy in the management of infective pancreatic necrosis.

METHODS: Clinical data for 45 SAP patients with infective pancreatic necrosis who were treated from January 2009 to December 2012 were analyzed retrospectively. These patients were divided into two groups based on the treatment choice. Twenty-one patients in the percutaneous drainage group underwent CT-guided percutaneous catheter drainage, and the efficacy was evaluated after 3 d. If no improvement was achieved, they would receive laparotomy. Twenty-four patients in the laparotomy group received surgical drainage when the diagnosis of infective pancreatic necrosis was confirmed.

RESULTS: Approximately 42.3% of patients in the percutaneous drainage group did not require laparotomy. The percutaneous drainage group had a significantly higher success rate of first laparotomy (91.7% vs 66.7%, P < 0.05), significantly lower rates of postoperative residual abscess (8.3% vs 33.3%, P < 0.05) and new organ dysfunction (9.5% vs 37.5%, P < 0.05), shorter hospital duration (46.71 d ± 10.96 d vs 55.93 d ± 11.54 d, P < 0.05) and less expenditure (181872 yuan ± 42011 yuan vs 2510000 yuan ± 57365 yuan, P < 0.05).

CONCLUSION: CT-guided percutaneous catheter drainage can effectively reduce the use of laparotomy, improve the success rate of first laparotomy, and decrease the rate of postoperative residual abscess and new organ dysfunction as well as the cost of medical resources.

Early continuous blood purification for treatment of severe acute pancreatitis: an analysis of 14 cases

AIM: To evaluate the clinical efficacy of early continuous blood purification (CBP) in patients with severe acute pancreatitis (SAP).

METHODS: Fourteen patients who were diagnosed with SAP and were willing to undergo early (within 48 h after onset) CBP were included in test group, while 12 SAP patients were included in control group. All patients received mechanical ventilation, parenteral nutrition, antibiotics, vasoactive drugs, somatostatin, or anti-disseminated intravascular coagulation treatment according to indications. The test group began to receive CBP within 8 hours after the diagnosis of SAP. APACHE II score and plasma TNF-α levels were compared before treatment and 1, 3, 5 days after treatment between the two groups.

RESULTS: Early CBP significantly improved the signs and symptoms of SAP. On days 1, 3 and 5, APACHE II score and plasma TNF-α levels differed significantly between the control group and the test group (APACHE II score: 15.93 ± 4.81 vs 18.50 ± 4.77, 13.71 ± 4.01 vs 18.08 ± 4.83, 10.79 ± 2.39 vs 15.17 ± 4.59; TNF-α: 60.00 ± 15.27 vs 89.08 ± 25.56, 42.14 ± 6.94 vs 89.83 ± 23.19, 39.00 ± 6.04 vs 80.00 ± 23.02, all P < 0.05). APACHE II score and plasma TNF-α levels decreased significantly in the test group on days 1, 3 and 5 compared to before treatment (all P < 0.05).

CONCLUSION: Early CBP can significantly improve clinical symptoms, protect organ function, improve prognosis, and reduce mortality in SAP patients.