胰腺炎,急性,重症

摘要： cqvip:1病例介绍,患者,男,23岁。2020年12月12日因确诊“结外NK/T细胞淋巴瘤,鼻型,Ⅳ期,淋巴瘤国际预后评分4分,复治”入本院血液内科就诊。入院体检:体温36.3°C,呼吸20次·min^(-1),脉搏113次·min^(-1),血压133/86 mmHg(1 mmHg=0.133 kPa);患者神志清,发育正常,体型肥胖,自主体位,体检合作。右眼视力下降,左眼上睑下垂,浅表淋巴结未触及肿大,咽不红,扁桃体不肿大,颈软,胸廓对称无畸形,双肺呼吸音清,未闻及明显干湿啰音。

摘要： 目的 总结临床药师参与1例肾功能亢进急性重症胰腺炎患者治疗方案调整的过程,为促进临床安全及合理用药提供参考.方法 针对1例急性重症胰腺炎患者,临床药师参与抗感染治疗方案的制定,对患者用药情况进行分析,提供建议并调整治疗方案.结果 经调整药物治疗方案,患者体温恢复正常.结论 临床药师应对抗感染治疗进行全程药学监护,对于肾功能亢进患者,应及时调整用药方案,以促进临床合理用药,保证患者用药安全.

摘要： Objective To investigate the effect of section of pancreatic envelope combined with vacuum sealing drainage under laparoscopy on inflammatory mediators of patients with early severe acute pancreatitis (SAP). Methods Forty-two SAP patients were admitted to Foshan Hospital of Traditional Chinese Medicine in Guangdong Province from January 2008 to December 2016. That 22 patients underwent pancreatic membrane incision and vacuum sealing drainage under laparoscopy was in the experimental group, and that 20 patients underwent the routine pancreatic membrane incision and double tube drainage was in the control group. The venous blood was collected, the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured before and after operation for 1, 3, 7 and 14 days, and the clinical therapeutic effects were observed in the two groups. Results With the prolongation of therapy, the levels of CRP, IL-6 and TNF-α were decreased continuously in both groups, the degrees of decrease of above indexes in experimental group were more significant than those in the control group, and the differences in these indexes between the two groups were statistically significant [CRP (mg/L): 1 day was 203.80±25.12 vs. 271.79±60.41, 3 day was 117.26±19.70 vs. 174.53±42.37; IL-6 (ng/L): 1 day was 40.63±3.38 vs. 57.10±11.46, 3 days was 23.14±3.51 vs. 46.87±10.69; TNF-α (ng/L): 1 day was 23.91±10.42 vs. 36.73±15.90, 3 days was 19.13±8.34 vs. 32.58±15.81, all P 0.05). The therapeutic efficacy of the experimental group was significantly higher than that of the control group [95.45% (21/22) vs. 90.0% (18/20), P 0.05).试验组临床总有效率明显高于对照组〔95.45%(21/22)比90.0%(18/20),P<0.05〕.结论 SAP早期在腹腔镜下行胰腺包膜切开联合负压封闭引流术能更迅速地控制机体的炎症反应,减少并发症,缩短病程.

摘要： 目的 观察血必净注射液联合益生菌对重症急性胰腺炎(SAP)患者炎症指标降钙素原(PCT)、C-反应蛋白(CRP)及微循环指标D-二聚体水平的影响.方法 选择2014年6月至2017年7月南通大学附属吴江医院收治的SAP患者92例,按治疗方法不同分为血必净组〔31例,将血必净注射液50 mL加入到0.9%生理盐水100 mL中静脉滴注(静滴),每次滴注30~40 min、每日2次〕和益生菌组(30例,口服复合乳酸菌胶囊,每粒0.33 g,每次2粒、每日3次)以及血必净+益生菌组(31例,静滴血必净的同时口服复合乳酸菌胶囊,用法同上).3组患者均给予抑酸、抗感染、抑制胰腺分泌、液体复苏等常规处理.于治疗前和治疗5 d、7 d取静脉血,检测血清PCT、CRP及血浆D-二聚体水平,并比较各组间上述指标的差异.结果 3组治疗后血清PCT、CRP及血浆D-二聚体水平均较治疗前明显降低,并随治疗时间延长降低更明显,治疗7 d时血必净+益生菌组的下降幅度最大,明显低于单用血必净组和益生菌组〔PCT(μg/L):1.21±1.05比2.37±0.84、2.43±0.69, CRP(mg/L):12.57±1.39比25.24±3.06、27.32±2.74,D-二聚体(mg/L):0.61±0.17比1.02±0.34、0.94±0.39〕,但血必净组、益生菌组上述指标比较差异无统计学意义(P>0.05).结论 血必净注射液联合益生菌能明显降低SAP患者血中PCT、CRP、D-二聚体水平,减轻患者炎症反应程度,且疗效较单用血必净或益生菌更明显,可对SAP患者起到早期保护作用.%Objective To investigate the effects of Xuebijing combined with probiotics on levels of inflammatory indexes of procalcitonin (PCT), C-reactive protein (CRP) and microcirculation index D-Dimer in patients with severe acute pancreatitis (SAP). Methods Ninety-two SAP patients admitted to the Affiliated Wujiang Hospital of Nantong University from June 2014 to July 2017 were enrolled, according to the difference in treatment, they were divided into three groups: Xuebijing group (n = 31) using 50 mL Xuebijing injection added into 100 mL 0.9% normal saline, intravenously dripped, each time lasting for 30-40 minutes, twice a day; probiotics group (n = 30) applying lactobacillus complex capsules (each capsule weight 0.33 g), 2 capsules once, 3 times a day; Xuebijing combined with probiotics group (n = 31) using the same as above two methods in combination. The routine therapies were given to the patients in the three groups, including anti-acid agents, anti-infection, anti-secretion of pancreas, fluid resuscitation, etc. The venous blood was collected before and after treatment for 5 days and 7 days, the serum PCT, CRP and plasma D-Dimer were detected and the differences in the above indexes among the three groups were compared. Results The serum PCT, CRP and plasma D-Dimer levels were significantly reduced in the three groups after treatment, and with the prolongation of therapeutic time, the reduction in the above index levels was more obvious, the amplitudes of descent in levels of indicators were mostly pronounced in Xuebijing combined with probiotics group on the 7th day of treatment, being significantly greater than those of single Xuebijing group or single probiotics group [PCT (μg/L): 1.21±1.05 vs. 2.37±0.84, 2.43±0.69, CRP (mg/L): 12.57±1.39 vs. 25.24±3.06, 27.32±2.74, D-Dimer (mg/L): 0.61±0.17 vs. 1.02±0.34, 0.94±0.39], however , the levels of PCT, CRP and D-Dimer were of no significant differences between Xuebijing group and probiotics group (all P > 0.05). Conclusions The Xuebijing injection combined with probiotics for treatment of patients with SAP can significantly reduce the levels of PCT, CRP and D-Dimer, ameliorate the inflammatory response, and the therapeutic effect was more evident compared with Xuebijing or probiotics treatment alone. Moreover, this combination therapy can provide early protection for SAP patients.

摘要： Objective To investigate the protective effect of hesperidin on severe acute pancreatitis (SAP) in rats and its related mechanism.Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into five groups (n = 12 in each group): sham group, SAP model group, dexamethasone group (5 mg/kg), low and high dose of hesperidin groups (10 mg/kg and 20 mg/kg). SAP rats were administered a retrograde infusion of 3.5％ sodium taurocholate solution into the biliopancreatic duct after laparotomy. Sham rats were administered with equivalent saline. The treatment was intravenously injected 5 minutes after operation through femoral vein. After 24 hours, the survival of animals was observed, the level of serum amylase, the volume of ascites and the relative specific gravity of the pancreas were measured; the pathological changes of pancreatic tissue were observed by Hematoxylin-eosin (HE) staining; the levels of serum and pancreatic tissue interleukin (IL-1β, IL-6) and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA); the expression of Toll-like receptor 4 (TLR4), the phosphorylation of IL-1 receptor associated kinase (IRAK1) and nuclear factor-κB (NF-κB) were detected by Western Blot.Results Compared with SAP model group, the 24-hour survival rate were increased in low and high dose of hesperidin groups (83.3％, 100％ vs. 58.3％), the volume of ascites were reduced (mL: 7.36±0.91, 6.10±1.02 vs. 13.82±2.06), the levels of serum amylase were reduced (U/L: 1081.48±78.23, 1048.58±49.97 vs. 1990.37±127.27), the relative specific gravity of the pancreas were reduced [(7.52±1.02)％, (5.59±0.96)％ vs. (11.22±0.96)％], and the pathological damage of pancreatic tissue were reduced; the levels of serum and pancreatic tissue inflammatory factors were reduced in high dose hesperidin group [serum IL-1β (ng/L): 68.08±10.49 vs. 130.30±23.35, IL-6 (ng/L): 63.88±10.47 vs. 158.41±21.38, TNF-α(ng/L): 10.42±1.49 vs. 18.16±2.01; pancreas IL-1β (pg/μg): 13.87±1.84 vs. 20.08±1.66, IL-6 (pg/μg): 21.90±3.12vs. 38.13±3.57, TNF-α (pg/μg): 1.88±0.20 vs. 4.26±0.58]; the expression of TLR4, and the phosphorylation levels of IRAK1 and NF-κB were decreased in low and high dose of hesperidin groups (the sham operation group was 100, TLR4/β-actin: 91.9±15.6, 83.7±11.2 vs. 168.5±9.0, p-IRAK1/IRAK1: 117.4±7.6, 104.7±11.5 vs. 173.5±15.8, p-NF-κB p65/NF-κB p65: 119.9±9.3, 105.8±12.6 vs. 174.1±13.0), with statistically significant differences (allP < 0.05). The effects of dexamethasone were similar to that of high dose of hesperidin.Conclusions Hesperidin could significantly protect SAP rats, and this protection was related to the inhibition of TLR4/IRAK1/NF-κB signaling pathway, and to the reduction of pro-inflammatory cytokine expressions. The effect of high dose hesperidin (20 mg/kg) was more significant.%目的 探讨橘皮苷对大鼠重症急性胰腺炎(SAP)治疗作用的机制.方法 将60只雄性SD大鼠按随机数字表法分为假手术组、SAP模型组、地塞米松组(5 mg/kg)、低剂量橘皮苷组(10 mg/kg)和高剂量橘皮苷组(20 mg/kg),每组12只.经胰管逆行注射3.5％牛磺胆酸钠建立SAP大鼠模型,假手术组注射生理盐水;术后5 min经股静脉注射相应药物.术后24 h观察动物存活情况,测定血清淀粉酶水平、腹水量和胰腺相对比重;苏木素-伊红(HE)染色后镜下观察胰腺组织病理学改变;酶联免疫吸附试验(ELISA)检测血清和胰腺组织白细胞介素(IL-1β、IL-6)和肿瘤坏死因子-α(TNF-α)水平;蛋白质免疫印迹试验(Western Blot)检测Toll样受体4(TLR4)表达以及白细胞介素-1受体相关激酶(IRAK1)、核转录因子-κB(NF-κB)磷酸化水平.结果 与SAP模型组比较,低、高剂量橘皮苷治疗后24 h动物存活率提高(83.3％、100％比58.3％),腹水量减少(mL:7.36±0.91、6.10±1.02比13.82±2.06),血清淀粉酶水平降低(U/L:1081.48±78.23、1048.58±49.97比1990.37±127.27),胰腺相对比重降低〔(7.52±1.02)％、(5.59±0.96)％比(11.22±0.96)％〕,胰腺组织病理损伤减轻;高剂量橘皮苷组血清和胰腺组织炎性因子水平明显降低〔血清IL-1β(ng/L):68.08±10.49比130.30±23.35,IL-6(ng/L):63.88±10.47比158.41±21.38,TNF-α(ng/L):10.42±1.49比18.16±2.01;胰腺IL-1β(pg/μg):13.87±1.84比20.08±1.66,IL-6(pg/μg):21.90±3.12比38.13±3.57,TNF-α(pg/μg):1.88±0.20比4.26±0.58〕;低、高剂量橘皮苷均可抑制TLR4表达及IRAK1、NF-κB磷酸化(以假手术组为100,TLR4/β-actin:91.9±15.6、83.7±11.2比168.5±9.0,p-IRAK1/IRAK1:117.4±7.6、104.7±11.5比173.5±15.8,p-NF-κB p65/NF-κB p65:119.9±9.3、105.8±12.6比174.1±13.0),差异均有统计学意义(均P<0.05).地塞米松治疗SAP的作用与高剂量橘皮苷相当.结论 橘皮苷可降低SAP大鼠24 h死亡率,治疗SAP的机制可能与抑制胰腺TLR4/IRAK1/NF-κB信号通路、减少炎性因子释放有关,高剂量橘皮苷(20 mg/kg)作用更为显著.

摘要： Severe acute pancreatitis (SAP) is accompanied with complex pathogenic course and high mortality. The imbalance of immune response is an important cause which leads the SAP patients to the severe situation and even death. The immunomodulatory therapy can regulate the imbalance of inflammation, alleviate SAP-associated organ injury, and improve the prognosis of patients. Previous immunomodulatory therapy had some problems, such as single-object and simple-method. In recent years, some new methods of immunomodulatory therapy, such as regulating the apoptosis and mature of immune cells, applying of mesenchymal stem cells (MSCs) and multi-regulation methods, provide some new ideas and hopes for SAP therapy. This paper reviewed the history and recent research progresses of SAP immunomodulatory therapy.%重症急性胰腺炎(SAP)病程复杂,预后凶险.免疫应答失衡是导致胰腺炎患者转向重症甚至死亡的重要原因.免疫调节治疗可调控机体失衡的炎症反应,减轻SAP相关器官损伤,改善患者预后.早期免疫调节措施存在对象单一、方式简单等问题.近年来新出现的治疗方式,如调节免疫细胞成熟与凋亡、应用间充质干细胞(MSCs)及多因素联合治疗等,为未来SAP的治疗提供了新的思路和希望.本文就SAP免疫调节的发展及近年来的新进展进行综述.

摘要： 重症急性胰腺炎（SAP）病程复杂,预后凶险.免疫应答失衡是导致胰腺炎患者转向重症甚至死亡的重要原因.免疫调节治疗可调控机体失衡的炎症反应,减轻SAP相关器官损伤,改善患者预后.早期免疫调节措施存在对象单一、方式简单等问题.近年来新出现的治疗方式,如调节免疫细胞成熟与凋亡、应用间充质干细胞（MSCs）及多因素联合治疗等,为未来SAP的治疗提供了新的思路和希望.本文就SAP免疫调节的发展及近年来的新进展进行综述.

摘要： Objective To explore the therapeutic effects of rhodiola on severe acute pancreatitis (SAP) in rats and its mechanisms.Methods A total of 72 healthy Sprague-Dawley (SD) rats were divided into a control group,SAP model group,and a rhodiola-treated group (RTO group) by random number table,24 rats in each group.The SAP model was replicated by the method of pancreatic head clamping.The pancreas was flipped only 3 times and then the abdomen was closed in the control group.The rats in control and SAP model groups were peritoneally injected with 10 mL/kg 0.9％ normal saline after modeling in the latter group,while the rats in the RTO group were peritoneally injected with 10 mL/kg rhodiola injection.Eight rats were randomly selected from each group at 12,24,and 36 hours after modeling to detect levels of serum amylase and lipase;serum levels of interleukin (IL-1β,IL-6 and IL-10) were detected by enzymelinked immunosorbent assay (ELISA).Pathological changes of the pancreas were observed under light microscope,the superoxide dismutase (SOD) content of pancreas was detected by xanthine oxidase method.The expression level of inducible nitric oxide synthase (iNOS) mRNA in the rat pancreatic tissue was detected by reverse transcriptionpolymerase chain reaction (RT-PCR).Results Compared with the control group,the serum levels of amylase,lipase,IL-1 β,IL-6,IL-10,and the iNOS mRNA expression in pancreatic tissue were significantly higher in the SAP model group (P ＜ 0.05),the SOD level was obviously decreased in the SAP model group compared with that in control group,and the degree of change at 36 hours after modeling was more significant [the serum amylase (U/L):4 155.0 ± 240.1 vs.917.4 ± 44.0,the lipase (U/L):401.0 ± 20.4 vs.66.7 ± 7.2,the SOD (U/mg):37.0 ± 5.6 vs.79.7 ± 6.7,the IL-1 β (ng/L):469.4 ± 27.5 vs.51.0 ± 6.0,the IL-6 (ng/L):467.4 ± 28.2 vs.58.0 ± 6.0,the IL-10 (ng/L):242.6 ± 18.9 vs.81.0 ± 6.0,the iNOS mRNA (× 102):88.5 ± 11.4 vs.0].Compared with the SAP model group,the levels of amylase,lipase,IL-1 β,IL-6,and iNOS mRNA were significantly lower,but SOD and IL-10 levels were significantly higher in the RTO group,and the degrees of change at 36 hours after modeling were more significant [the serum amylase (U/L) was 3 656.8 ± 162.4,the lipase (U/L) was 360.8 ± 16.9,the SOD (U/mg) was 46.8 ± 5.8,the IL-1 β (ng/L) was 357.6 ± 24.1,the IL-6 (ng/L) was 356.9 ± 23.5,IL-10 (ng/L) was 372.6 ± 21.4,iNOS mRNA (× 102) was 61.2 ± 9.8,all P ＜ 0.05].At each time point,the pancreatic tissues were not of any abnormal changes in the control group;in the SAP model group,the mild swelling of pancreatic tissue and slight blood vessel dilatation could be seen.The morphological damage of pancreas in the RTO group was milder than that in the SAP model group.Under light microscope,there were no abnormal changes in pancreatic tissue in the control group,while in the SAP model group,the pancreatic pathologic changes included interstitial edema with a large amount of inflammatory cell infiltration,acinar cells representing vacuole-like changes,focal necrosis,fat necrosis at the periphery of pancreas,some of the alveolar cells being dissolved,leaving only the remaining disintegrating cells.In the RTO group,the pancreas was still hyperemic and swelling,but interstitial inflammatory cells were significantly less than those in the SAP model group,only could petechial hemorrhage and spotty necrosis be seen.Conclusions Rhodiola has relatively good therapeutic effect on SAP in rats,which might be related mainly to its actions of inhibiting the levels of IL-1 β,IL-6 to promote inflamrnation,stimulating the expression of anti-inflammatory factor IL-10,preventing the decrease of anti-oxidation enzyme SOD,down-regulating iNOS mRNA expression,reducing the generation of oxygen free radicals and NO damage to pancreatic cells,and improving the pancreas capability of hypoxia tolerance.%目的 探讨红景天治疗重症急性胰腺炎(SAP)大鼠的作用及机制.方法 将72只健康SD大鼠按随机数字表法分为对照组、SAP模型组、红景天干预组,每组24只.采用胰头夹闭法复制SAP模型;对照组开腹仅翻动胰腺3次然后关腹.对照组和SAP模型组给予10 mL/kg 0.9％生理盐水(NS)腹腔注射,红景天干预组腹腔注射10 mL/kg的红景天注射液.于制模后12、24、36 h随机取8只大鼠检测各组血淀粉酶、脂肪酶水平;用酶联免疫吸附试验(ELISA)检测血清白细胞介素(IL-1 β、IL-6和IL-10)含量,再取胰腺组织行病理组织学观察,用间羟胺法检测大鼠胰腺组织超氧化物歧化酶(SOD)含量,用反转录-聚合酶链反应(RT-PCR)检测大鼠胰腺组织诱导型一氧化氮合酶(iNOS) mRNA表达水平.结果 SAP模型组血淀粉酶、脂肪酶、IL-1 β、IL-6、IL-10水平及胰腺组织iNOS mRNA表达水平均显著高于对照组,而SOD水平较对照组明显降低,以制模型后36 h变化更显著[血淀粉酶(U/L):4 155.0±240.1比917.4±44.0,脂肪酶(U/L):401.0±20.4比66.7±7.2,SOD (U/mg):37.0±5.6比79.7±6.7,IL-1 β(ng/L):469.4±27.5比51.0±6.0,IL-6 (ng/L):467.4±28.2比58.0±6.0,IL-10 (ng/L):242.6±18.9比81.0±6.0,iNOS mRNA(×102):88.5±11.4比0];红[景天干预组血淀粉酶、脂肪酶和IL-1 β、IL-6、iNOSmRNA水平较SAP模型组显著降低,而IL-10与SOD较SAP模型组明显升高,以制模型后制模后36 h变化更显著,红景天干预组血淀粉酶(U/L)为3 656.8±162.4,血脂肪酶(U/L)为360.8±16.9,SOD(U/mg)为46.8±5.8,IL-1 β(ng/L)为357.6±24.1,IL-6 (ng/L)为356.9±23.5,IL-10 (ng/L)为372.6±21.4,iNOS mRNA(×102)为61.2±9.8,红景天干预组与模型组比较差异均有统计学意义(均P＜0.05).对照组各时间点胰腺组织无异常;SAP模型组可见胰腺组织轻度肿胀,胰腺血管扩张;红景天干预组较SAP模型组胰腺损伤减轻.光镜下可见对照组胰腺组织结构无异常,SAP模型组胰腺间质水肿和大量炎性细胞浸润,胰腺泡细胞呈空泡样变和局灶性坏死,胰周脂肪组织坏死,部分腺泡细胞溶解,只剩下残留解体细胞.而红景天干预组见胰腺仍充血肿胀,但间质中炎性细胞明显减少,仅有点状出血坏死.结论 红景天对SAP大鼠有较好的治疗作用,主要与抑制大鼠胰腺组织促炎细胞因子IL-1 β、IL-6水平,促进抗炎性因子IL-10表达,阻止抗氧化酶SOD的下降,下调iNOS的mRNA表达,减少氧自由基的生成及一氧化氮(NO)对胰腺细胞的损害和提高胰腺的耐缺氧能力有关.

摘要： Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.%目的 探讨早期连续性血液净化(CBP)治疗对重症急性胰腺炎(SAP)患者的抗炎作用及治疗时机.方法 采用回顾性研究方法,选择2013年5月至2017年2月武汉市第一医院重症医学科收治的160例SAP患者,所有患者入院后均采用连续性静脉-静脉血液滤过(CVVH)模式行CBP治疗,血流量150~200 mL/min,置换液流速2000~3500 mL/h,维持超滤率35 mL·kg-1·h-1.根据入院24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分将患者分为15~19分组(A组)、20~24分组(B组)、25~29分组(C组)、≥30分组(D组),每组40例.比较不同APACHEⅡ评分组患者治疗前和治疗后72 h血中脂联素、内毒素、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-6、IL-8)水平的差异,观察APACHEⅡ、多器官功能障碍评分综合征(MODS)、全身炎症反应综合征(SIRS)评分、治疗后14 d内并发症发生情况及病死率的变化.结果 与治疗前比较,各APACHEⅡ评分组患者治疗后血中内毒素、TNF-α、IL-6、IL-8水平均明显降低,脂联素明显升高,其中B组、C组各指标变化幅度更为明显〔内毒素(EU/L):2.9±1.0比3.6±1.5,3.1±1.2比3.8±1.4;TNF-α(μg/L):100.5±15.3比177.5±24.6,113.7±17.2比190.4±25.8;IL-6(μg/L):107.3±13.5比230.5±32.4,118.2±16.1比244.6±30.2;IL-8(μg/L):201.5±25.7比355.6±47.2,215.4±29.4比376.4±47.3;脂联素(mg/L):21.9±3.6比17.6±3.4,20.8±3.7比15.8±2.9,均P<0.05〕.与治疗前比较,A、B、C组患者治疗后APACHEⅡ、MODS和SIRS评分均明显降低,其中B组、C组各评分降低幅度更为明显〔APACHEⅡ(分):16.2±1.4比22.9±1.7,18.2±1.4比28.3±2.1;MODS(分):4.4±1.5比7.7±1.8,5.2±1.6比8.7±1.8;SIRS(分):2.7±0.8比3.4±1.2,3.1±0.8比3.9±1.5,均P<0.05〕,D组APACHEⅡ 和SIRS评分降低幅度不明显,MODS评分反而有升高趋势.治疗后14 d,A、B、C、D组病死率分别为0%、0%、12.5%、47.5%(χ2=8.350,P=0.039),并发症发生率分别为32.5%、52.5%、60.0%、80.0%(χ2=27.04,P=0.028).结论 早期CBP治疗能减轻SAP患者炎症反应,20分≤APACHEⅡ评分<30分时进行CBP治疗的效果较好.

摘要： 目的 探讨肠梗阻导管联用生长抑素治疗重症急性胰腺炎的疗效.方法 选取重症急性胰腺炎患者105例,分为观察组、对照1组和对照2组,各35例.观察组采用肠梗阻导管联用生长抑素治疗,对照1组采用鼻胃管联用生长抑素治疗,对照2组采用肠梗阻导管进行胃肠减压.比较3组临床检测指标转归时间及患者住院时间.结果 3组血液C反应蛋白(CRP)、脂肪酶(LPS)、腹胀和腹痛的情况和腹膜炎症状的转归天数以及住院天数,每天肠胃减压引流量,疗效,2周后的出院率和病死率差异均有统计学意义(均P＜ 0.05).结论 肠梗阻导管联用生长抑素治疗重症急性胰腺炎疗效满意,值得临床推广.

摘要： 本发明提供了一种急性胰腺炎预后标志物、急性胰腺炎预后预测模型及其应用，所述标志物包括hsa‑miR‑4265、hsa‑miR‑1208、hsa‑miR‑516a或hsa‑miR‑3127中的任意一种或至少两种的组合。本发明的hsa‑miR‑4265、hsa‑miR‑1208、hsa‑miR‑516a和hsa‑miR‑3127与发生持续性器官衰竭的急性胰腺炎具有显著的相关性，根据上述标志物的相对表达量有助于构建急性胰腺炎预后预测模型，个体化预测急性胰腺炎患者是否发生持续性器官衰竭，为急性胰腺炎患者提供准确、有用的预后信息。

摘要： 本发明涉及一种治疗重症急性胰腺炎后胰腺假性囊肿的药物及其制备方法，其由以下原料制成：党参15～20份、茯苓20～30份、陈皮10～15份、豆蔻10～15份、炒白术10～20份、薏苡仁15～30份、山药20～30份、炒麦芽20～30份、红花10～15份、穿山甲5～10份、丹参20～30份和鸡血藤20～30份。本发明药物能健脾益气、活血散结，对治疗胰腺假性囊肿有确切的疗效，可有效解决脾胃虚弱和脉络瘀阻的问题。

摘要： 本发明提供了人乳脂球表面生长因子8（MFG‑E8）的一种新的医药用途，即人乳脂球表面生长因子8在预防/治疗重症急性胰腺炎中的用途。在小鼠重症急性胰腺炎中，静脉注射外源性人乳脂球表面生长因子8可以显著改善胰腺功能，减轻胰腺凋亡，减少胰腺组织损伤和细胞死亡，改善炎症介质释放和炎症细胞的浸润，减低重症急性胰腺炎小鼠死亡率，表明人乳脂球表面生长因子8能显著改善重症急性胰腺炎，人乳脂球表面生长因子8可以作为新的预防/治疗重症急性胰腺炎药物或者药靶进行开发。

摘要： 本发明提供了一种急性胰腺炎预后标志物、急性胰腺炎预后预测模型及其应用，所述标志物包括hsa‑miR‑4265、hsa‑miR‑1208、hsa‑miR‑516a或hsa‑miR‑3127中的任意一种或至少两种的组合。本发明的hsa‑miR‑4265、hsa‑miR‑1208、hsa‑miR‑516a和hsa‑miR‑3127与发生持续性器官衰竭的急性胰腺炎具有显著的相关性，根据上述标志物的相对表达量有助于构建急性胰腺炎预后预测模型，个体化预测急性胰腺炎患者是否发生持续性器官衰竭，为急性胰腺炎患者提供准确、有用的预后信息。

摘要： 本发明涉及一种治疗重症急性胰腺炎后胰腺假性囊肿的药物及其制备方法，其由以下原料制成：党参15～20份、茯苓20～30份、陈皮10～15份、豆蔻10～15份、炒白术10～20份、薏苡仁15～30份、山药20～30份、炒麦芽20～30份、红花10～15份、穿山甲5～10份、丹参20～30份和鸡血藤20～30份。本发明药物能健脾益气、活血散结，对治疗胰腺假性囊肿有确切的疗效，可有效解决脾胃虚弱和脉络瘀阻的问题。

摘要： 本发明公开了一种连翘酯苷A或其药用盐在制备预防或治疗重症急性胰腺炎并发脑损伤的药物中的应用。本发明不仅明确了连翘酯苷A具有抗重症急性胰腺炎并发脑损伤作用，而且为重症急性胰腺炎并发脑损伤临床治疗提供了新的手段。

摘要： 本发明属于生物医药领域，涉及一种标志物，特别是指一种重症急性胰腺炎疾病的标志物及其应用。本申请通过腺相关病毒介导的TXNIP过表达（AAV‑TXNIP）或敲低（shTXNIP）小鼠来进一步验证TXNIP在SAP中的作用以及相关的分子机制。总之，我们的体内实验和体外实验研究证明了TXNIP的缺失通过抑制炎症反应和氧化应激来减轻SAP。同时我们还发现，TXNIP的缺失对SAP的保护作用依赖于ASK1‑JNK/p38信号通路。AAV介导的TXNIP敲低减轻小鼠肺和肾脏组织学损伤及病例评分均减轻，从而证明了本申请的药物可实现改善重症急性胰腺炎的问题。

摘要： 本实用新型公开了一种急性重症胰腺炎病人用的芒硝外敷袋，包括长条状且具有弹性的扣板，所述扣板的两侧对称设置有弹性的扣带，位于所述扣板的中间开设有圆形的储槽，所述储槽的内部设置有储药袋，所述储药袋的中间设置有开口，且开口处对应设置有拉链，位于所述储槽的外侧设置有用于压紧储药袋的加固结构。本实用新型可预先将储药袋的内部倒入药材，然后将扣板贴附在腹部，使用扣带进行固定，再通过使用加固结构进行挤压储药袋，使得储药袋与胰腺位置进行紧密贴合，提高治疗效果。

摘要： 本实用新型公开了一种急性重症性胰腺炎冲洗清创专用引流袋，包括：肚皮贴、连接片、封边夹和引流袋，所述连接片固定连接在肚皮贴上，所述封边夹设置两组，封边夹均固定连接于连接片上，封边夹包括两个夹板，两个夹板一端通过弯折部连接一体，且可绕弯折部相对转动；所述引流袋顶端设置有左封口和右封口，所述左封口和右封口为形状相同的弧形，左封口和右封口上均连接有封边；所述左封口内设置弹性封条，所述右封口内设置固定封条，固定封条和弹性封条均为弧形。本实用新型通过设置弧形的封边夹操作简单快捷，利于快速更换引流袋；通过在袋口设置弹性的封边条，在更换引流袋时可大大减少内部污水溅出造成污染。

摘要： 本实用新型公开了一种急性重症胰腺炎引流用渗液收集器，涉及医疗用品技术领域。包括收集盒，所述收集盒顶部的一侧固定设置有气管，所述气管的一端固定设置有过滤装置，所述过滤装置的内部活动设置有香料盒，所述香料盒上开设有第一通孔，所述香料盒的一侧活动设置有盖板，所述盖板上开设有第二通孔，所述香料盒上开设有卡槽，且卡槽的内壁卡接有卡杆，所述香料盒的内部活动设置有转轴，所述转轴的表面固定设置有搅拌杆。通过设置风机以及香料盒，风机将收集盒内的异味气体抽入到过滤装置的内部，香料盒的内部添加有香料颗粒，香料会散发令人舒适的香味，与异味气体混合可以改善异味，从而避免异味污染环境。