Department of Gastroenterology and Hepatology, University Hospitals Leuven.
Department of Translational Research in Gastrointestinal Diseases (TARGID), Catholic University Leuven.
Curr Opin Crit Care. 2021 Apr 1;27(2):193-200. doi: 10.1097/MCC.0000000000000806.
With a potentially life-threatening course, acute pancreatitis (AP) is one of the most common gastrointestinal diseases requiring hospitalization and often necessitating intensive care. Based on recent insights and recommendations, this review provides an overview on clinical management of AP patients with a focus on intensive care unit care.
Possible benefits of percutaneous paracentesis and/or drainage on outcome or inflammation have been further explored. Combined opioid and epidural analgesia for pain management might be a valuable alternative for pain management. Very recent international guidelines now agree on a step-up approach for the management of acute necrotizing pancreatitis favoring a minimally invasive approach with either endoscopic or percutaneous drainage first. Studies for the best timing of these interventions are ongoing. In spite of a better understanding of pathophysiological mechanisms mediating AP, specific treatments are still awaited.
New evidence and recent international consensus direct the current management of AP toward a tailored, multidisciplinary and less invasive therapy with complementary roles for hepatologists, intensivists, radiologists, and surgeons.
急性胰腺炎（AP）是一种潜在危及生命的疾病，是最常见的胃肠道疾病之一，需要住院治疗，经常需要重症监护。基于最近的研究结果和建议，本综述概述了 AP 患者的临床管理，重点是重症监护病房的护理。
经皮穿刺引流术对预后或炎症的可能益处进一步得到了探讨。联合应用阿片类药物和硬膜外镇痛用于疼痛管理可能是一种有价值的替代方法。最近的国际指南现在就急性坏死性胰腺炎的管理达成了一致，支持采用逐步治疗方法，首先采用内镜或经皮引流的微创方法。目前正在进行这些干预措施最佳时机的研究。尽管对介导 AP 的病理生理机制有了更好的理解，但仍在等待特定的治疗方法。
新的证据和最近的国际共识指导着 AP 的当前管理，采用个体化、多学科和微创治疗方法，肝科医生、重症监护医生、放射科医生和外科医生发挥互补作用。
