Department of Internal Medicine II, LMU Hospital, Munich, Germany; Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leibzig, Germany; German Society of Gastroenterology, Digestive and Metabolic Disease (DGVS), Berlin, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; LMU Hospital, Munich, Germany.
Dtsch Arztebl Int. 2022 Jul 25;119(29-30):495-501. doi: 10.3238/arztebl.m2022.0223.
Acute pancreatitis (AP) is among the commonest non-malignant admission diagnoses in gastroenterology. Its incidence in Germany lies between 13 and 43 per 100 000 inhabitants and is increasing. In 2017, 24 per 100 000 inhabitants were hospitalized for chronic pancreatitis.
From October 2018 to January 2019, we systematically searched the literature for original articles, meta-analyses, and evidence-based guidelines that were published in German or English between 1960 and 2018.
30-50% of cases of acute pancreatitis are caused by gallstone disease, and another 30-50% are due to alcohol abuse. The diagnosis is made when at least two of the following three criteria are met: typical abdominal pain, elevation of serum lipase, and characteristic imaging findings. If those criteria are ambiguous, transabdominal sonography is indicated. The early initiation of food intake lowers the rate of infected pancreatic necrosis, organ failure, or death (odds ratio 0.44; 95% confidence interval [0.2; 0.96]). In AP, Ringer's lactate solution should be preferred for fluid resuscitation, at 200-250 mL/hr for 24 hours. Severe pain should be treated with opiates.
The current German clinical practice guideline reflects the developments in the diagnosis and treatment of pancreatitis that have taken place over the past few years. The long-term care and monitoring of patients with complication-free pancreatitis is the responsibility of primary care physicians and gastroenterologists.
急性胰腺炎（AP）是消化内科最常见的非恶性入院诊断之一。德国的发病率为每 10 万人中有 13 至 43 例，并且呈上升趋势。2017 年，每 10 万人中有 24 人因慢性胰腺炎住院。
我们从 2018 年 10 月至 2019 年 1 月，系统地检索了德语或英语发表的 1960 年至 2018 年间的原始文章、荟萃分析和循证指南。
30%-50%的急性胰腺炎是由胆石病引起的，另有 30%-50%是由酗酒引起的。当至少满足以下三个标准中的两个时即可作出诊断：典型腹痛、血清脂肪酶升高和特征性影像学发现。如果这些标准不明确，则需要进行腹部超声检查。早期开始进食可降低感染性胰腺坏死、器官衰竭或死亡的发生率（比值比 0.44；95%置信区间[0.2；0.96]）。在急性胰腺炎中，应首选乳酸林格氏液进行液体复苏，速度为 200-250 mL/hr，持续 24 小时。严重疼痛应使用阿片类药物治疗。
目前的德国临床实践指南反映了过去几年中胰腺炎诊断和治疗方面的发展。无并发症胰腺炎患者的长期护理和监测是初级保健医生和胃肠病学家的责任。
