Takeda Kazunori, Takada Tadahiro, Kawarada Yoshifumi, Hirata Koichi, Mayumi Toshihiko, Yoshida Masahiro, Sekimoto Miho, Hirota Masahiko, Kimura Yasutoshi, Isaji Shuji, Koizumi Masaru, Otsuki Makoto, Matsuno Seiki
Department of Surgery, National Hospital Organization Sendai Medical Center, Miyagino-ku, Sendai 983-8520, Japan.
J Hepatobiliary Pancreat Surg. 2006;13(1):42-7. doi: 10.1007/s00534-005-1050-8.
The basic principles of the initial management of acute pancreatitis are adequate monitoring of vital signs, fluid replacement, correction of any electrolyte imbalance, nutritional support, and the prevention of local and systemic complications. Patients with severe acute pancreatitis should be transferred to a medical facility where adequate monitoring and intensive medical care are available. Strict cardiovascular and respiratory monitoring is mandatory for maintaining the cardiopulmonary system in patients with severe acute pancreatitis. Maximum fluid replacement is needed to stabilize the cardiovascular system. Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with necrotizing pancreatitis. Although the efficacy of the intravenous administration of protease inhibitors is still a matter of controversy, there is a consensus in Japan that a large dose of a synthetic protease inhibitor should be given to patients with severe acute pancreatitis in order to prevent organ failure and other complications. Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with severe acute pancreatitis. The JPN Guidelines recommend, as optional measures, blood purification therapy and continuous regional arterial infusion of a protease inhibitor and antibiotics, depending on the patient's condition.
急性胰腺炎初始治疗的基本原则包括对生命体征进行充分监测、补充液体、纠正任何电解质失衡、营养支持以及预防局部和全身并发症。重症急性胰腺炎患者应转至具备充分监测和强化医疗护理条件的医疗机构。对于重症急性胰腺炎患者,严格的心血管和呼吸监测对于维持心肺系统功能至关重要。需要进行最大量的液体补充以稳定心血管系统。对于坏死性胰腺炎患者,建议预防性使用抗生素以预防感染性并发症。尽管静脉注射蛋白酶抑制剂的疗效仍存在争议,但在日本,人们达成的共识是应给予重症急性胰腺炎患者大剂量合成蛋白酶抑制剂,以预防器官衰竭和其他并发症。在对重症急性胰腺炎患者进行营养支持方面,肠内营养优于肠外营养。日本指南建议,根据患者情况,血液净化疗法以及持续区域性动脉输注蛋白酶抑制剂和抗生素作为可选措施使用。