Acute pancreatitis is one of the common clinical acute abdominal diseases, which is mainly characterized by acute epigastric pain, abdominal distension, fever, accompanied by nausea, vomiting, and increased blood and urine amylase, and is often triggered by alcohol abuse, overeating, and over-eating high-fat food.
Most cases are mild pancreatitis, which can be completely cured within 5-7 days after fasting and rehydration, while a few cases are severe pancreatitis, which requires multidisciplinary management, but some patients may still have complications.
Although the basic and clinical research on acute pancreatitis has made great progress in recent years with the joint efforts of scholars at home and abroad, and the mortality rate and complication rate of acute pancreatitis have decreased significantly, its etiology is complex and the pathogenesis is still not completely elucidated.
The etiology of acute pancreatitis is complex and diverse, and many diseases are associated with its occurrence.
Comprehensive reports from various countries, the most important cause of acute pancreatitis is still biliary disease and ethanol (commonly known as alcohol) ingestion, and the proportion of these two factors varies according to the population, race, economic and health conditions, such as Sweden and the Netherlands, alcohol ingestion is the main cause, while the United Kingdom and Germany are dominated by gallstone disease.
However, in recent years, the incidence of acute pancreatitis due to ischemic injury, metabolic abnormalities, sphincter of Oddi dysfunction, drugs, pancreatic surgery, trauma, etc. is also on the rise.
I. Western medical treatment
1.Treatment for the cause of the disease
Biliary acute pancreatitis: first of all, we must identify the presence of biliary obstruction lesions. Anyone with biliary obstruction must be promptly relieved of the obstruction.
2, non-surgical treatment
(1) fluid resuscitation, maintenance of water-electrolyte balance and intensive monitoring treatment. Due to the large amount of peripancreatic and retroperitoneal leakage, resulting in blood volume loss and hemoconcentration, and due to the presence of capillary leakage, dynamic monitoring of C V P or PW CP and H CT is needed as a guide for volume expansion, and attention should be paid to the crystalloid ratio to reduce tissue interstitial fluid retention. 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, such as fasting, gastrointestinal decompression, acid and enzyme suppression therapy.
(3) Prophylactic antibiotic application: mainly for enterogenic gram-negative bacilli translocation, antibiotics that can pass the blood-pancreatic barrier should be used, such as quinolones, ceftazidime, carbapenems and metronidazole.
(4) Sedation, antispasmodic and analgesic treatment.
(5) Chinese herbal treatment: 30g of raw rhubarb, 3og of mannitol by intra-gastric tube infusion or rectal infusion, 3 times a day. Chinese herbal medicine and its external application to the whole abdomen.
(6) Prevention of fungal infection: Fluconazole can be used.
(7) Nutritional support: after the correction of the internal environment disorder, 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 strong condition of intestinal function, choose the appropriate formula, concentration and speed, and must gradually increase the amount, while closely observing the tolerance reaction.
Combined Chinese and Western medicine treatment
In the process of clinical diagnosis and treatment, the advantages of Chinese medicine in treating severe acute pancreatitis are emphasized, and the Chinese medicine treatment system for SAP is being gradually formed and improved.
The treatment principle of “Yi-huo-qing-xia”, that is, “pass through the lining and attack the lower part of the body, clear heat and detoxify the body, activate blood circulation and remove blood stasis, strengthen the spleen and stomach, and benefit qi and nourish yin”, is the centralized embodiment of this system.
Its mechanism of action includes: relieving intestinal paralysis and promoting the emptying of large amounts of intestinal contents, improving the microcirculation of the pancreas and peripancreatic area, promoting the internal drainage of pancreatic juice and bile, increasing blood perfusion and tissue oxygen utilization in vital organs and pancreas, blocking systemic reperfusion damage and endothelial damage, resisting cytokine self-injury, protecting the intestinal axial membrane barrier and maintaining the intestinal microecosystem, clearing and lowering endotoxin and endotoxemia, inhibiting the activity of pancreatic enzymes that enter the blood circulation, and promoting the development of pancreatic function. The activity of pancreatic enzymes is beneficial to the symptom relief and glandular recovery of severe acute pancreatitis.
Chinese herbal medicine treatment together with western medicine conventional treatment can achieve twice the effect with half the effort.
Third, prevention
Include removing the causes and avoiding the triggers, such as abstaining from alcohol, not overeating, treating hyperlipidemia, etc. Diet in moderation. Careful diet and prevention of overeating are very important to prevent this disease. At the same time, the elderly should eat a light diet, less spicy, fatty and sweet, alcoholic wine and thick taste, to prevent the accumulation of heat in the stomach and intestines to cause the disease.
Actively prevent and treat primary diseases, such as biliary diseases, hyperparathyroidism, hyperlipidemia, etc.
Do not abuse alcohol and drink less alcohol. Long-term alcoholics are prone to chronic alcoholism, alcoholism is one of the important causes of chronic pancreatitis, so from youth should develop a good habit of not drinking alcohol or just a small amount of alcohol. If you have chronic pancreatitis, in order to prevent the development of the disease, you must completely stop drinking.
The mood is relaxed. It is advisable to avoid bad mental stimulation such as worry, depression and anger, a happy mood, the qi is smooth, blood flow, can prevent the disease.