重症急性胰腺炎发病机制研究现状

Effect of adjuvant treatment with magnesium isonipecotate on CAM-1 and SIL-2R levels and liver and kidney function in patients with severe acute pancreatitis

AIM

To investigate the effect of adjuvant treatment with magnesium isoglycyrrhizinate on cell adhesion molecule-1 (CAM-1) and soluble interleukin-2 receptor (SIL-2R) levels and liver and kidney function in patients with severe acute pancreatitis (SAP).

METHODS

Eighty-three patients with SAP admitted to our hospital from January 2015 to September 2017 were enrolled. The patients were randomly divided into either an observation group (42 patients) or a control group (41 patients). Both groups were given routine treatment, and the observation group was additionally given intravenous magnesium isoglycyrrhizinate. The changes of CAM-1, SIL-2R, and liver and renal function were compared between the two groups.

RESULTS

After intervention, CAM-1 and SIL-2R levels in the observation group were significantly lower than those in the control group (P < 0.05). Alanine aminotransferase, aspartate aminotransferase, and total bilirubin were significantly lower in the observation group than in the control group (P < 0.05). The levels of urea nitrogen and serum creatinine in the observation group were also significantly lower than those in the control group (P < 0.05). The total proportion of patients with liver or renal dysfunction in the observation group was significantly lower than that in the control group (P < 0.05).

CONCLUSION

The use of magnesium isoglycyrrhizinate for the treatment of SAP can effectively reduce the body's inflammatory response, maintain liver and kidney function, and reduce the incidence of liver and kidney function damage.

Diagnosis and treatment of severe acute pancreatitis: Current status and main problems

Acute pancreatitis (AP) is a disease of various causes, characterized by pancreatic enzyme activation and local pancreatic inflammatory response. Serious cases may develop systemic inflammatory response syndrome and even organ dysfunction. Severe AP (SAP) as a category of AP associated with persistent organ failure (>48 h) has an acute onset and high fatality rate. SAP accounts for about 5%-10% of all AP cases, with 30%-50% mortality rate. In this paper, we discuss the current status and main problems on the diagnosis and treatment of SAP based on the literature and our experience.

Effect of glutamine combined with esomeprazole on amino acid metabolism, bacterial translocation and inflammatory reaction in patients with severe acute pancreatitis

AIM

To evaluate the effect of glutamine combined with esomeprazole on amino acid metabolism, bacterial translocation (BT) and inflammatory reaction in patients with severe acute pancreatitis (SAP).

METHODS

Seventy patients with acute severe pancreatitis were randomly divided into either a control group or an observation group. The control group was given esomeprazole alone, and the observation group was treated with glutamine combined with esomeprazole. Amino acid metabolism, BT and inflammatory reaction were compared between the two groups.

RESULTS

With regard to amino acid metabolism, serum tryptophan, histidine, lysine, arginine, phenylalanine, valine, and isoleucine in the control group were all significantly lower than those of the observation group (P < 0.05). For intestinal BT, the numbers of Lactobacilli and Bifidobacteria in the control group were significantly lower than those of the observation group, and the numbers of Staphylococci, Escherichia, and Candida were significantly higher than those of the observation group (P < 0.05). With regard to inflammatory response, serum levels of interleukin-6, hypersensitive C-reactive protein, and tumor necrosis factor-α in the control group were significantly higher than those of the observation group.

CONCLUSION

Glutamine combined with esomeprazole therapy is helpful to improve amino acid metabolism, prevent BT, and reduce inflammatory reaction in patients with SAP.

Clinical and nursing efficacy of blood purification combined with ulinastatin in treatment of patients with severe acute pancreatitis

AIM: To analyze the clinical and nursing efficacy of blood purification combined with ulinastatin in the treatment of patients with severe acute pancreatitis.

METHODS: Eighty-eight patients with severe acute pancreatitis treated at our hospital were divided into either a control group or a treatment group, both of which received conventional treatment, blood purification and quality nursing. The treatment group was additionally given ulinastatin. Clinical efficacy was observed and compared for the two groups.

RESULTS: The time to amylase recovery, time to abdominal pain relief, time to first anal exhaust and hospital stay in the treatment group were 4.17 d ± 0.95 d, 1.55 d ± 0.76 d, 4.26 d ± 1.23 d and 23.94 d ± 4.21 d, respectively, which were significantly lower than those in the control group (5.34 d ± 1.13 d, 2.74 d ± 0.93 d, 5.84 d ± 1.41 d, 29.43 d ± 4.34 d, P < 0.05). The total response rate for the treatment group was 75.00%, which was significantly higher than that for the control group (P < 0.05).

CONCLUSION: Blood purification combined with ulinastatin and quality nursing is effective in the treatment of patients with severe acute pancreatitis.

Clinical characteristics of mild acute pancreatitis with acute liver injury

AIM: To explore the clinical characteristics of mild acute pancreatitis (MAP) with acute liver injury.

METHODS: Ninety-three patients with MAP were divided into either an acute liver injury group (n = 61) or a non-acute liver injury group (n = 32). The clinical data, laboratory indexes, and MAP stage (abdominal pain relief time, serum amylase recovery time and hospital stay) were compared between the two groups. In addition, the 93 patients were divided into a biliary MAP group (n = 52) or a non-biliary MAP group (n = 41). The liver injury (alanine aminotransferase, aspartic transaminase, total bilirubin, DBIL) and MAP stage were compared between the two groups. The prognosis of the patients with acute liver injury was observed.

RESULTS: The percentages of patients between 45-59 years of age and those with hyperlipidemic pancreatitis were significantly lower in the acute liver injury group than in the non-acute liver injury group (24.59% vs 56.25%, 9.84% vs 28.13%, P < 0.05). The percentages of patients aged > 60 years and those with biliary pancreatitis, blood glucose concentration > 6.1 mmol/L or peritoneal irritation sign were significantly higher in the acute liver injury group than in the non-acute liver injury group (52.46% vs 12.50%, 65.57% vs 37.50%, 63.93% vs 34.38%, 55.74% vs 31.25%, P < 0.05). The abdominal pain relief time, serum amylase recovery time and hospital stay were significantly shorter in the acute liver injury group than in the non-acute liver injury group (5.52 d ± 2.21 d vs 4.10 d ± 1.72 d, 6.11 d ± 3.14 d vs 4.20 d ± 2.16 d, 11.60 d ± 5.26 d vs 8.52 d ± 3.57 d, P < 0.05). The liver function indexes were significantly higher in the biliary MAP group than in the non-biliary MAP group (182.33 U/L ± 157.06 U/L vs 48.82 U/L ± 51.05 U/L, 185.22 U/L ± 176.30 U/L vs 36.31 U/L ± 22.24 U/L, 36.74 μmol/L ± 28.13 μmol/L vs 25.92 μmol/L ± 9.60 μmol/L, 16.61 μmol/L ± 17.51 μmol/L vs 5.10 μmol/L ± 4.61 μmol/L, P < 0.05). Serum amylase recovery time and hospital stay in the biliary MAP group were significantly longer than those in the non-biliary MAP group (6.83 d ± 3.01 d vs 4.60 d ± 2.91 d, 12.52 d ± 5.40 d vs 9.38 d ± 4.33 d, P < 0.05). Of 61 patients with acute liver injury, liver function indexes returned to normal in 39 (63.93%) cases 1-3 wk before discharge, and in 22 (36.07%) cases 1-2 wk after discharge.

CONCLUSION: Hepatic injury may occur in early MAP patients and lead to the prolongation of disease duration. Hepatic injury may recover with the cure of primary disease. Old age, biliary pancreatitis, hyperglycemia and peritoneal irritation sign are risk factors for hepatic injury in MAP patients.

Risk factors and nursing strategies for severe acute pancreatitis complicated with multiple organ dysfunction syndrome

AIM: To explore the risk factors and nursing strategies for severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).

METHODS: Clinical data for 134 patients with SAP were retrospectively analyzed. Based on the presence of MODS or not, the patients were divided into two groups, those complicated with or without MODS. Risk factors and nursing strategies for SAP with MODS were then analyzed.

RESULTS: Logistic regression analysis demonstrated that shock, biliary obstruction, hyperlipidemia, hypoxemia, lung infection, pleural effusion, abdominal cavity room partition syndrome and Ranson's score, APACHE II score, and CT score were independent risk factors for SAP complicated with MODS (OR = 1.193, 1.016, 1.004, 1.193, 1.049, 1.055, 1.081, 1.100, 1.027, all P < 0.05). Nursing for SAP with MODS should focus on monitoring the patient's vital signs and strengthening the management of respiratory function, renal function, blood coagulation function and intestinal function.

CONCLUSION: Awareness of risk factors for SAP complicated with MODS should be raised to conduct active intervention to improve prognosis. Optimization of nursing management of SAP complicated with MODS can help reduce mortality.