【摘要】：目的:本文將闡述急性膽源性胰腺炎(Acute biliary pancreatitis,ABP)的分型及診斷,連續(xù)性血液凈化(Continuous blood purification,CBP)的作用機制及治療重癥急性胰腺炎(Severe acute pancreatitis,SAP)的原理,分析連續(xù)性血液凈化在重癥急性膽源性胰腺炎治療中的應用。背景:急性膽源性胰腺炎發(fā)病率及病死率高,如何早期、有效、積極的治療是當今危重癥領域的一大重點。內鏡介入治療可以有效的解除膽道梗阻、去除病因,是急性膽源性胰腺炎患者最為安全有效的治療方法。但存在部分急性膽源性胰腺炎患者,存在明顯梗阻征象但無法行內鏡介入治療,或是無梗阻征象但存在明顯重癥傾向,此類患者行內科保守治療無法顯著改善病情,治療上存在難度。連續(xù)性血液凈化作為近30年來血液凈化領域最新成就,近年來臨床上推廣應用連續(xù)性血液凈化治療重癥急性胰腺炎,顯著降低重癥急性胰腺炎患者死亡率,成為一種有效的搶救方法。方法:查找相關文獻資料,分析總結連續(xù)性血液凈化在重癥急性膽源性胰腺炎患者治療中的作用機制及治療效果等方面的研究進展。結果:對于存在內鏡介入治療禁忌癥的重癥梗阻型急性膽源性胰腺炎患者,可先予以連續(xù)性血液凈化治療清除血漿中過量炎癥介質,減輕對組織器官損害,待患者生命體征平穩(wěn),胰頭及十二指腸壁水腫減輕時及時行內鏡介入治療解除梗阻、去除病因。對于重癥非梗阻型急性膽源性胰腺炎患者,應及時行連續(xù)性血液凈化治療,顯著改善患者預后。結論:對于重癥急性膽源性胰腺炎患者,除傳統手術及內鏡介入治療外,連續(xù)性血液凈化可作為一種有效的治療方法。
[Abstract]:Objective: to describe the classification and diagnosis of acute biliary pancreatitis (Acute biliary), the mechanism of continuous blood purification of (Continuous blood purificationus (Continuous blood) and the principle of treatment of severe acute pancreatitis (SAP). To analyze the application of continuous blood purification in the treatment of severe acute biliary pancreatitis. Background: the incidence and mortality of acute biliary pancreatitis are high. Endoscopic interventional therapy can effectively relieve biliary obstruction and remove the etiology, which is the safest and most effective treatment for acute biliary pancreatitis. But in some patients with acute biliary pancreatitis, there were obvious signs of obstruction but could not be treated by endoscopy, or there was no sign of obstruction, but there was a significant tendency to severe disease. Medical conservative treatment could not significantly improve the condition of this kind of patients. Treatment is difficult. Continuous blood purification is the latest achievement in the field of blood purification in recent 30 years. In recent years, the application of continuous blood purification in the treatment of severe acute pancreatitis has been popularized, and the mortality rate of patients with severe acute pancreatitis has been significantly reduced. Become an effective rescue method. Methods: the research progress of continuous blood purification in the treatment of severe acute biliary pancreatitis was analyzed. Results: for patients with severe obstructive acute biliary pancreatitis with contraindication of endoscopic interventional therapy, continuous blood purification therapy could be given first to remove excessive inflammatory mediators in plasma and reduce the damage to tissues and organs. When the patient's vital signs were stable and the edema of the pancreatic head and duodenal wall were alleviated, endoscopic interventional therapy was used to relieve the obstruction and remove the etiology. In order to improve the prognosis of patients with severe non-obstructive acute biliary pancreatitis, continuous blood purification should be performed in time. Conclusion: continuous blood purification can be used as an effective treatment for patients with severe acute biliary pancreatitis in addition to traditional surgery and endoscopic interventional therapy.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R576

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