连续性血液净化在急性胆源性胰腺炎中的应用

发布时间：2018-08-04 09:25

【摘要】：目的:本文将阐述急性胆源性胰腺炎(Acute biliary pancreatitis,ABP)的分型及诊断,连续性血液净化(Continuous blood purification,CBP)的作用机制及治疗重症急性胰腺炎(Severe acute pancreatitis,SAP)的原理,分析连续性血液净化在重症急性胆源性胰腺炎治疗中的应用。背景:急性胆源性胰腺炎发病率及病死率高,如何早期、有效、积极的治疗是当今危重症领域的一大重点。内镜介入治疗可以有效的解除胆道梗阻、去除病因,是急性胆源性胰腺炎患者最为安全有效的治疗方法。但存在部分急性胆源性胰腺炎患者,存在明显梗阻征象但无法行内镜介入治疗,或是无梗阻征象但存在明显重症倾向,此类患者行内科保守治疗无法显著改善病情,治疗上存在难度。连续性血液净化作为近30年来血液净化领域最新成就,近年来临床上推广应用连续性血液净化治疗重症急性胰腺炎,显著降低重症急性胰腺炎患者死亡率,成为一种有效的抢救方法。方法:查找相关文献资料,分析总结连续性血液净化在重症急性胆源性胰腺炎患者治疗中的作用机制及治疗效果等方面的研究进展。结果:对于存在内镜介入治疗禁忌症的重症梗阻型急性胆源性胰腺炎患者,可先予以连续性血液净化治疗清除血浆中过量炎症介质,减轻对组织器官损害,待患者生命体征平稳,胰头及十二指肠壁水肿减轻时及时行内镜介入治疗解除梗阻、去除病因。对于重症非梗阻型急性胆源性胰腺炎患者,应及时行连续性血液净化治疗,显著改善患者预后。结论:对于重症急性胆源性胰腺炎患者,除传统手术及内镜介入治疗外,连续性血液净化可作为一种有效的治疗方法。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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