Early and aggressive comprehensive medical treatment of severe acute pancreatitis can reduce mortality, and comprehensive treatment under the guidance of “individualized treatment plan” has become the main means of treating SAP in recent years, the core of which is to adopt different treatment and observation methods for patients with different etiologies and stages of disease: non-surgical treatment is used for early stage, necrotic and uninfected patients. , surgery is only used to deal with complications such as secondary pancreatic infection, I as a surgeon, however, I advocate for conservative treatment of severe acute pancreatitis. 1, antispasmodic and analgesic: painful stimulation during SAP leads to faster respiratory rate, hypoxia, increased non-significant fluid loss, reduced pulmonary ventilation, impedes pulmonary function and increases the risk of venous thrombosis. Severe abdominal pain can cause or aggravate shock and may also lead to pancreatic-heart reflex and sudden death. Therefore, rapid and effective pain relief is very important, it is recommended that the combination of painkillers and antispasmodics (such as pethidine hydrochloride + atropine), morphine is prohibited to avoid causing spasm of the sphincter of Oddi. 2, adequate oxygen supply: SAP patients have or may have hypoxemia, easily complicated by respiratory insufficiency, interstitial pulmonary edema, acute lung injury (ALI), ARDS, etc., so the early stage should be continuous oxygenation, while closely monitoring oxygen saturation and blood gas analysis. Once the manifestation of respiratory insufficiency appears, ventilator support therapy should be performed as early as possible, and the principle of “early in the morning” should be followed. 3, prevention and control of pancreatic necrosis: research shows that pancreatic microcirculatory disorders are one of the initiating factors of SAP, and pancreatic ischemia is the main cause of pancreatic necrosis. The severity of pancreatitis is positively correlated with the degree of damage to the pancreatic microcirculation perfusion. It is recommended to apply compound salvia and low molecular dextran on the basis of blood volume replenishment to improve the microcirculation of the pancreas and correct the hypercoagulable state of SAP patients, which can improve the cure rate. 4, inhibit pancreatic secretion and pancreatic enzyme activity: growth inhibitor can inhibit pancreatic secretion, have a protective effect on pancreatic cells, inhibit inflammatory mediators, and prevent systemic inflammatory response syndrome (SIRS). Zendradine has a long half-life, is inexpensive, and has a simple route of administration. Growth inhibitors were used in all cases in our group and had good efficacy, significantly reducing mortality while simplifying the treatment regimen. The application time of growth inhibitor should be based on CT review results as a reference indicator, especially for patients with grade E should be extended for 3-5 days to ensure the therapeutic effect. Pancreatic enzymes are activated early in the development of acute pancreatitis and are involved in pancreatic injury, and exocrine secretion of the pancreas is further stimulated by hydrolysis and digestion of the pancreatic alveoli, while the role of pancreatic enzyme inhibitors (gabexate or ustekin) is mainly in prevention rather than treatment, especially effective in preventing pancreatitis caused by endoscopic retrograde cholangiopancreatography (ERCP). Therefore, drugs that inhibit pancreatic enzymes and pancreatic exocrine secretion should be used as early as possible to block further activation and release of pancreatic enzymes. Proton pump inhibitors are also essential drugs to reduce pancreatic exocrine secretion through strong acid inhibition. The combined application of the above drugs can shorten the course of treatment, reduce the occurrence of complications and reduce the death rate. 5, prevention and control of infection: pancreatic necrosis is prone to secondary infection, 80% of deaths are related to infection. The International Pancreatic Association still recommends the use of broad-spectrum antibiotics, and I recommend the use of high-dose effective antibiotics at the beginning of the disease. 6, nutritional support: reasonable nutritional support has a positive effect on reversing the malnutrition of the body and stopping the deterioration of SAP and its evolution to benign. I personally believe that nutritional support therapy is crucial, especially the timing of combined total gastrointestinal nutrition (TPN) and total enteral nutrition (TEN) therapy is important.