I. Diagnosis
Diagnostic criteria for severe acute pancreatitis
1, acute pancreatitis with organ dysfunction, or those with local complications such as necrosis, abscesses or pseudocysts, or both.
2, abdominal signs: significant pressure pain in the upper abdomen, rebound pain, muscle tension, abdominal distension, diminished or absent bowel sounds, etc. There may be abdominal masses, and occasionally subcutaneous bruises in the lumbar ribs and subcutaneous bruises around the umbilicus.
3.It can be complicated by one or more organ dysfunction, and can also be accompanied by severe metabolic dysfunction.
4, previous history of cholelithiasis and history of biliary colic or episodes of biliary pancreatitis.
5. Ultrasound and CT of the common bile duct showed an internal diameter greater than 1 cm.
Treatment of severe acute pancreatitis
1.Conventional treatment
(1) fluid resuscitation, maintenance of water-electrolyte balance and intensive monitoring treatment. Due to the large amount of peripancreatic and retroperitoneal exudate, resulting in blood volume loss and hemoconcentration, and due to the presence of capillary leakage, dynamic monitoring of central venous pressure or pulmonary capillary wedge pressure and erythrocyte pressure product is needed as a guide for volume expansion, and attention should be paid to the crystalloid ratio to reduce interstitial fluid retention in tissues. Changes in urine volume and intra-abdominal pressure should be observed, and attention should be paid to the maintenance of the body’s oxygen supply and monitoring of visceral function.
(2) Pancreatic rest therapy.
(3) Prophylactic antibiotic application.
(4) Sedation, antispasmodic and analgesic treatment. Valium, scopolamine, dulcolax, etc. can be administered intramuscularly.
(5) Intragastric injection of Chinese herbal medicine Qing Pancreatic Tang, twice a day, or 15g of Chinese herbal medicine Sheng Da Huang, intragastric instillation or rectal drip, twice a day. Chinese herbal medicine skin nitrate is applied externally to the whole abdomen, 500g, twice daily. It mainly plays the role of selective intestinal decontamination.
(6) Prevention of fungal infection: Because fluconazole is effective against most Candida, it can be given orally or intravenously and can pass the blood-brain and blood-pancreas barriers, and other toxic side effects are rare except for slight liver damage, it can be used as the drug of choice for empirical or prophylactic treatment with a dose of 200-400mg/d.
(7) Nutritional support: after the correction of the disorder of the internal environment, before the recovery of intestinal function, parenteral nutrition can be used as appropriate; once the recovery of intestinal function, enteral nutrition should be carried out early, and the nasojejunal tube infusion method must be used, according to the status of intestinal function, the appropriate formula, concentration and speed should be selected, and the dosage must be gradually increased, while closely observing the tolerance reaction.
(8) Immunotherapy.
(9) The use of vasoactive drugs.
(10) Prophylactic treatment of intestinal failure.
(11) Hemopurification techniques for treatment of hemodialysis, plasma exchange and hemofiltration.
(12) Interventional treatment: femoral artery cannulation under local anesthesia, selective or super-selective placement of tubing in the celiac artery, superior pancreaticoduodenal artery, dorsal pancreatic artery or large pancreatic artery for regional perfusion.
2.Non-surgical treatment
One of the principles that must be followed for non-surgical treatment is cause-specific treatment. For example, biliary pancreatitis must be timely removal of biliary obstruction; hyperlipidemic pancreatitis must try to reduce blood lipids; hypercalcemic acute pancreatitis is mostly related to hyperparathyroidism and requires calcium-lowering therapy.