Munoz A, Katerndahl D A
University of Texas Health Science Center, San Antonio, USA.
Am Fam Physician. 2000 Jul 1;62(1):164-74.
Acute pancreatitis usually occurs as a result of alcohol abuse or bile duct obstruction. A careful review of the patient's history and appropriate laboratory studies can help the physician identify the etiology of the condition and guide management. Serum amylase and lipase levels are still used to confirm the diagnosis of acute pancreatitis. Although not routinely available, the serum trypsin level is the most accurate laboratory indicator for pancreatitis. Ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography are additional modalities that can help the family physician choose the best treatment approach. Prompt identification of patients who need intensive care referral or subspecialty consultation is crucial. The APACHE II and the multiple organ system failure scales provide prognostic information at the time of admission and may be repeated daily to monitor disease progression. Therapies such as nasogastric suctioning, anticholinergics and histamine H2-receptor blockers have not been shown to decrease symptoms or hospital stays in patients with acute pancreatitis. Systemic antibiotics have been found to improve outcome in patients with severe disease. With supportive care, most patients have a good clinical outcome.
急性胰腺炎通常是由酗酒或胆管梗阻引起的。仔细回顾患者病史并进行适当的实验室检查有助于医生确定病因并指导治疗。血清淀粉酶和脂肪酶水平仍用于确诊急性胰腺炎。血清胰蛋白酶水平虽然并非常规检测项目，但却是胰腺炎最准确的实验室指标。超声检查、计算机断层扫描和内镜逆行胰胆管造影是其他有助于家庭医生选择最佳治疗方法的检查手段。及时识别需要重症监护转诊或专科会诊的患者至关重要。急性生理与慢性健康状况评分系统II（APACHE II）和多器官系统衰竭量表可在入院时提供预后信息，并且可每日重复使用以监测疾病进展。诸如鼻胃管抽吸、抗胆碱能药物和组胺H2受体阻滞剂等治疗方法尚未显示能减轻急性胰腺炎患者的症状或缩短住院时间。已发现全身性抗生素可改善重症患者的预后。通过支持性治疗，大多数患者都有良好的临床结局。
