【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(jī)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(yīng)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(dāng)今危重癥領(lǐng)域的一大重點(diǎn)。內(nèi)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(nèi)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(nèi)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(lǐng)域最新成就,近年來臨床上推廣應(yīng)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(guān)文獻(xiàn)資料,分析總結(jié)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(jī)制及治療效果等方面的研究進(jìn)展。結(jié)果:對于存在內(nèi)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(zhì),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(shí)及時(shí)行內(nèi)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(yīng)及時(shí)行連續(xù)性血液凈化治療,顯著改善患者預(yù)后。結(jié)論:對于重癥急性膽源性胰腺炎患者,除傳統(tǒng)手術(shù)及內(nèi)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(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 于清霞;夏永宏;王靜;高艷玲;劉魯沂;;急性胰腺炎嚴(yán)重程度和預(yù)后與降鈣素原、C反應(yīng)蛋白、高遷移率族蛋白B1的關(guān)系[J];中華實(shí)驗(yàn)外科雜志;2014年09期

2 羅克勤;施旖旎;常建星;;連續(xù)性血液凈化對重癥急性胰腺炎血漿炎癥介質(zhì)的影響[J];嶺南現(xiàn)代臨床外科;2013年04期

3 黃克剛;;血液灌流聯(lián)合血液透析治療急性重癥胰腺炎43例臨床療效觀察[J];中國醫(yī)藥指南;2013年09期

4 毛杰;李梅;王儉勤;宋愛琳;陳曉;王文革;董晨明;張有成;;連續(xù)靜-靜脈血液透析濾過在重癥急性胰腺炎治療中的內(nèi)環(huán)境穩(wěn)態(tài)維持作用[J];蘭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2011年03期

5 秦靜;趙振林;;急性膽源性胰腺炎不同治療方法的療效分析[J];中國普通外科雜志;2011年03期

6 謝泉琨;黨勇;;血液濾過聯(lián)合血液灌流治療重癥急性胰腺炎療效觀察[J];中國實(shí)用醫(yī)藥;2011年06期

7 李永勝;高紅宇;于丹;周亞光;李樹生;楊光田;;持續(xù)性與間歇性血液凈化治療重癥急性胰腺炎合并急性腎衰竭的療效比較[J];內(nèi)科急危重癥雜志;2010年03期

8 劉斌;羅仁;;血液濾過聯(lián)合血液灌流治療重癥急性胰腺炎臨床療效分析[J];中國醫(yī)藥指南;2010年16期

9 陳勁松;馮志松;;細(xì)胞因子在重癥急性胰腺炎早期診斷中的作用[J];國際內(nèi)科學(xué)雜志;2009年08期

10 Hans G Beger;Bettina M Rau;;Severe acute pancreatitis: Clinical course and management[J];World Journal of Gastroenterology;2007年38期

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本文編號：2163394