【Abstract】Objective To investigate a more rational modality which is in the treatment of severe acute pancreatitis (SAP) and effective in preventing liver from damages due to SAP. Methods SAP model was established by retrograde injection of 5% sodium taurocholate (1.0 ml) in the subserosa of pancreas in rats (n=80) weighting 200-250 g.The rats were catheterized using PE-50 angiocatheter from femoral artery to celiac trunk. Then they were randomly divided into four groups. Twenty animals served as controls (A group) and received only fluid infusion. The 40 animals, B and C group (20 animals in each one group) received continuous regional arterial infusion (CRAI) of somatostatin （4 μɡ/kg） and the medicines improving microcirculatory (dextran-40 1.5 ml, dopamine hydrochloride 5 μg/kg, anisodaminum 1.5 ml/kg) respectively. The other 20 animals (D group) were treated by somatostatin combined with the medicine improving microcirculatory through CRAI simultaneously with the induction of pancreatitis. The AST, ALT, ALP and serum amylase were recorded, the liver and pancreas tissue were observed pathologicaly after 6 hours. Results There were a ignificant decrease in the serum amylase in B group (Plt;0.05) and D group (Plt;0.05). The AST, ALT, ALP was decreased in B and D group (Plt;0.05). The damage to liver and pancreas were reduced in D group. Conclusion CRAI is effective in preventing liver damages due to SAP and is an effective way in the treatment of SAP.
【Abstract】Objective To study the influence of early hemofiltration on plasma concentrations of proinflammatory cytokines TNF-α and IL-1β and their transcription levels in severe acute pancreatitis (SAP) pigs. Methods The model of SAP was induced by retrograde injection of artificial bile into pancreatic duct in pigs. Animals were divided randomly into two groups: SAP hemofiltration treatment group (HF group, n=8) and SAP no hemofiltration treatment group (NHF group, n=8). TNF-α and IL-1β plasma concentrations were measured by ELISA. Their transcription levels in the tissues of pancreas, liver and lung were assayed by semi-quantitative reverse transcription polymerase chain reaction. Results After hemofiltration treatment, the plasma concentrations of TNF-α and IL-1β increased gradually but were lower than those of NHF group at the same time spot 〔at 6 h after hemofiltration treatment, (618±276) pg/ml vs (1 375±334) pg/ml and (445±141) pg/ml vs (965±265) pg/ml, P＜0.01〕. At 6 h after hemofiltration treatment, the transcription levels of TNF-α and IL-1β in tissues of pancreas, liver and lung were lower than in NHF group (57.8±8.9 vs 85.7±17.4, 48.0±8.1 vs 78.1±10.2, 46.2±9.6 vs 82.4±10.5; 55.9±9.0 vs 82.2±15.7, 40.6±9.2 vs 60.0±10.6, 35.7±9.8 vs 58.1±9.3, P＜0.01). Conclusion Early hemofiltration can reduce TNF-α and IL-1β plasma concentrations and transcription levels in SAP pigs.
Objective To investigate the mechanism of radix salviae miltiorrhizae (RSM) injection in treatment of pancreatitis through observing the changes of activity of nuclear factor-kappa B (NF-κB) in pancreas of rats with severe acute pancreatitis (SAP) and the influence of RSM injection upon NF-κB in pancreas tissue. Methods Seventy-five rats were randomly divided into 3 groups: normal control group, SAP group and RSM treatment group, which were injected with normal saline, normal saline or RSM in the peritoneal cavity, respectively. The model of SAP rats was made by injecting L-arginine into peritoneal cavity and by subcutaneous injection at the same time. The concentrations of amylase in plasma and in ascites were measured respectively, and the expression of NF-κB in pancreas tissues was determined by immunohistochemistry. Results The levels of amylase in plasm and ascites in SAP group and RSM treatment group increased significantly with the increased expression of NF-κB in pancreas tissue, but it was also found that both the level of amylase and the expression of NF-κB in RSM treatment group were significantly lower compared with those in SAP group, and the survival time of RSM treatment group was longer than SAP group with less pathological injury in the pancreas tissues. Conclusion RSM may be effective for the treatment of pancreatitis by degrading the expression of NF-κB.
To evaluate the role of octreotide in the treatment of severe acute pancreatitis (SAP). Seventy-six patients were divided into two groups (octreotide group, n＝38, control group, n＝38). All patients were treated by the same conservative regime. The octreotide group received octreotide. Results: The abdominal symptoms and signs, WBC count, serum amylase level, and volume of ascites were more effective controlled, with fewer complications occurred in octreotide group. Conclusion: Octreotide has a beneficial effect on the treatment of SAP, but the mechanism will be further investigated.
ObjectiveTo investigate correlation of bedside index for severity in acute pancreatitis (BISAP) and computed tomography severity index (CTSI) or modified CT severity index (MCTSI) in assessing severe acute pancreatitis (SAP). MethodsThirty-eight patients confirmed SAP from July 2015 to October 2015 in West China Hospital of Sichuan University were prospectively included into this study. Contrast-enhanced multi-detector-row CT scan was performed for all the patients. The abnormal imaging features, such as pancreatic and peri-pancreatic inflammatory changes, involvement of other organs, and local complications, were observed and used to calculate by CTSI score and MCTSI score. The clinical data were also collected to calculate BISAP score and as compared with CTSI score and MCTSI score. ResultsThe results of BISAP score were as follows:3 cases gradeⅠ(8.9%), 20 cases gradeⅡ(52.6%), 15 cases gradeⅢ(39.5%). The results of CTSI score were as follows:6 cases gradeⅠ(15.8%), 22 cases gradeⅡ(57.9%), 10 cases gradeⅢ(26.3%). The results of MCTSI score were as follows:2 cases gradeⅠ(5.3%), 19 cases gradeⅡ(50.0%), 17 cases gradeⅢ(44.7%). The results of interobserver agreement were good (BISAP:Kappa=1, P < 0.01; CTSI:Kappa=0.748, 95% CI 0.00-0.076, P < 0.01; MCTSI:Kappa=0.788, 95% CI 0.00-0.076, P < 0.01). There was a positive correlation between CTSI score (rs=0.385, P=0.001) or MCTSI score (rs=0.326, P=0.004) and BISAP score using the Spearman test. ConclusionThere is a weak correlation between CTSI score or MCTSI score and BISAP score.
Severe acute pancreatitis (SAP) is a serious acute inflammatory disease with complex pathogenesis, rapid progression, high mortality, extensive treatment, and heavy socioeconomic burden, which is often complicated by systemic multiple organ dysfunction. Renal replacement therapy (RRT) is essential for removing inflammatory mediators, cytokines or other toxins, as well as stabilizing the internal environment. Therefore, RRT is utilized as an organ support technology in the clinical management of SAP. Currently, there is no consensus regarding when and under what circumstances RRT can be employed in patients with SAP. In this paper, the pathogenesis of SAP and the indications and timing of initiation of RRT will be discussed.
ObjectiveTo systematically review the efficacy and safety of early abdominal paracentesis drainage (APD) in patients with severe acute pancreatitis (SAP). MethodsThe PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials and cohort studies on the management of SAP via early APD from inception to December 10, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software and Stata 17.0 software. ResultsEighteen studies were included, with a total sample size of 2 685 patients. The meta-analysis showed that early APD could decrease mortality (OR=0.49, 95%CI 0.35 to 0.69, P<0.01) and the incidences of multiple organ failure (OR=0.56, 95%CI 0.45 to 0.71, P<0.01), ARDS (OR=0.54, 95%CI 0.41 to 0.71, P<0.01), and infectious complications (OR=0.72, 95%CI 0.57 to 0.92, P<0.01) and also reduce the need for further interventions and the total cost incurred during hospitalization, reduce the length of hospital stay, and reduce the number of days spent in the intensive care unit. However, there were no significant differences in the incidence of pneumonia, bacteremia, and sepsis between the two groups. ConclusionThe treatment of SAP via early APD, which has high clinical value, could decrease the incidence of multiple organ failure, improve the prognosis of patients, and reduce the associated mortality rate. Moreover, APD does not increase the risk of infection-related complications. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To investigate the efficiency of combining traditional Chinese medicine with western medicine in the treatment of severe acute pancreatitis (SAP). Methods The clinical results of sixty three cases of SAP of non-operative treatment with injection of Salia miltorrhizae composita, and oral or gastric tube feeding of decoction Qing-Yi-Tang were retrospectively studied. Results Thirty four cases were categorised as SAP Ⅰ grade, and 29 cases as SAP Ⅱ grade. A variety of complications occurred in 19 cases (30.16%), 3 patients died (4.76%), and 4 patients developing abscess of pancreas (6.35%) which had to be operated on.Conclusion The individualization principle on the basis of cause and clinical stage of the disease should be stressed in treating SAP. The patients who had complication needing to be operated on should be timely performed. There is a good efficiency in the treatment of SAP with the traditional Chinese medicine combining with western medicine.
Objective To discuss the feasibility and safety of early enteral nutrition (EN) on treatment of severe acute pancreatitis (SAP) and its influence. Methods The advancement about application of early EN on treatment of SAP in recent years were reviewed. Results In patients with SAP, early EN via catheter placed in the jejunum could protect the integrity of intestinal barrier and reduce infectious complications. But no consensus had been reached about the starting time, ingredient and infusion mode yet. Conclusion Early EN may have positive effects on treatment of SAP, but further researches are still needed.
Objective To explore the effect of early enteral nutrition in the clinical treatment of severe acute pancreatitis (SAP). Methods Forty-two SAP patients who improved with non-surgical treatments between January 2012 and December 2014 were selected and randomly divided into control group and study group with 21 patients in each. Patients in the control group accepted whole venous nutrition, while those in the study group had early enteral nutrition. Nutrition indexes, blood biological indexes, and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score on day 7 and 14 after treatment, and average hospital stay of the two groups of patients were recorded and compared. Results No differences in body weight reduction, lymphocytes, serum albumin, calcium, glucose, APACHE Ⅱ score between the two groups after 7 days of treatment were observed (P>0.05). But there were significant differences in body weight, lymphocytes, serum albumin, and APACHE Ⅱ score between these two groups after 14 days of treatment (P<0.05). Hospital stay of the study group was obviously shorter (P<0.01). Conclusions Early enteral nutrition support for patients with severe acute pancreatitis can improve nutritional status and shorten hospital stay. It is worthy of wider clinical application.