Severe acute pancreatitis (SAP) is a common gastrointestinal disease, often accompanied by systemic inflammatory reactions and organ dysfunction. SAP has an acute onset, severe condition, rapid progression, and poor prognosis. The development of SAP is closely related to the excessive release of inflammatory factors. In the comprehensive treatment of SAP, continuous blood purification (CBP) can clear inflammatory mediators, improve the stability of Internal environment, improve organ function, reduce blood lipids, regulate immunity, and significantly improve the condition of SAP patients. It is an important means of treating SAP. This article reviews the research progress of CBP in the treatment of SAP.

Objective:To analyze the influence of factors before initiation of extracorporeal cardiopulmonary resuscitation (ECPR) on the prognosis of patients, so as to explore the intervention timing and improvement strategy of ECPR.Methods:A retrospective analysis was performed on 29 patients who underwent ECPR in the First Affiliated Hospital of Hunan Normal University (Hunan people's Hospital)from July 2018 to April 2021. Patients were divided into the survival group ( n = 13) and death group ( n = 16) according to whether they survived at discharge. The duration of conventional cardiopulmonary resuscitation (CCPR), initial heart rate before ECPR, the ratio of out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), and the ratio of transported cases outside the hospital were compared between the two groups. According to different CCPR time, the patients were divided into the ≤45 min group, 45-60 min group and >60 min group to compare the hospital survival and sustained return of spontaneous circulation (ROSC) rate . According to the location of cardiac arrest, the patients from emergency department and other department were divided to compare the survival of IHCA. Results:The total survival rate was 44.83%, the average duration of extracorporeal membrane oxygenation (ECMO) was 114 (33.5, 142.5) h, and the average duration of CCPR time was 60 (44.5, 80) min. The duration of ECMO was longer in the survival group than in the death group ( P = 0.001). The duration of CCPR (the time from CPR to ECMO) in the survival group was significantly shorter than that in the death group ( P = 0.010). Patients with defibrillatory rhythm had higher hospital survival rate ( P = 0.010). OHCA patients had higher mortality than IHCA patients ( P = 0.020). Mortality of patients transferred from other hospitals was higher ( P = 0.025). Hospital survival and ROSC decreased in turn by CCPR duration ≤ 45 min, 45-60 min, and > 60 min ( P = 0.001). The location of CA occurrence had no impact on the hospital survival rate of IHCA patients ( P=0.54). Conclusions:Hospital survival of ECPR is higher than that of CCPR. ECPR is effective for refractory cardiac arrest. The prognosis of ECPR is significantly related to the duration of CCPR, initial heart rate, and location of CA. Education and team training should be strengthened to improve the survival rate of ECPR.

[目的]探讨清胰汤对重症急性胰腺炎(SAP)大鼠血清白介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)、淀粉酶(AMY)、钙离子(Ca2+)以及胰腺组织病理评分的影响.[方法]将30只健康SD大鼠随机分为假手术组(SO组)、SAP组及SAP清胰汤治疗组(QYT组),每组10只.SO组:仅开腹翻动胰腺后关腹;用5％牛磺胆酸钠经胰管逆行注射(1mg/kg)构造SAP模型.建模后24h三组大鼠均进行再次开腹,观察其腹水、腹腔内皂化斑及胰腺大体形态改变,测定大鼠血清AMY、Ca2+、TNF-α、IL-6及IL-10水平,并对胰腺组织进行病理学评分.[结果]SAP组可见全胰腺充血水肿、坏死及片状出血;QYT组大鼠可见全胰腺充血水肿,点状出血及坏死灶,SO组大鼠未见上述改变.清胰汤组血清TNF-α、IL-6、IL-10、AMY值及病理学评分明均显著低于SAP组(P<0.05),但高于假手术组(P<0.05).清胰汤组的血清钙离子浓度显著高于SAP组(P<0.05),低于SO组(P<0.05).[结论]以清胰汤经胃灌注SAP大鼠可降低血清TNF-α、IL-6、IL-10炎症因子的释放,减轻胰腺组织的出血、坏死,进而起到一定的治疗作用.

溺水的致死原因主要是气管内吸入大量水分阻碍呼吸,或因喉头强烈痉挛,引起呼吸道关闭,窒息时间持续5-6 分钟,可引起呼吸、心搏骤停,因此溺水救治必须争分夺秒,现场能否就地及时正确处理,对提高抢救成功率、降低病死率和后遗症极为重要.

重症急性胰腺炎(severe acute pancreatitis,SAP)是一种病情凶险、并发症多的严重疾病,患者常伴有腹腔高压(intra abdominal hyper tension,IAH).IAH使机体产生一系列病理生理改变,对呼吸系统、循环系统、肾脏等产生损害,甚至会导致腹腔间隔室综合征(abdominal compartment syndrome,ACS)的发生[1].IAH和ACS间的界限难以界定,2007年腹腔间隔室综合征世界联合会(World Society of the Abdominal Compartment Syndrome,WSACS)在ACS专题会议上将ACS定义为持续的腹内压(IAP)＞ 20 mmHg(伴或不伴腹腔灌注压＜ 60 mmHg,1 mmHg=0.133 kPa),并伴有新的器官功能不全或衰竭[2].据文献[3-5]统计,SAP患者中IAH的发病率在60％ ～ 80％,合并ACS患者达50％ ～ 70％,是影响胰腺炎病情进展、手术时机及预后的重要因素。

重症急性胰腺炎(severe acute pancreatitis,SAP)常合并胃肠功能紊乱,导致胃肠动力障碍,甚至引起胃肠功能衰竭,对SAP病程和预后有着重要的影响,是导致SAP患者死亡的重要原因,直接影响着重症急性胰腺炎本身的治疗效果和预后,为判定重症急性胰腺炎预后的重要指标之一.本文旨在通过文献复习总结SAP合并胃肠功能障碍的病理生理学变化、发病机制及当前的诊治进展.

目的:探讨床旁超声引导经皮腹腔穿刺置管引流治疗重症急性胰腺炎早期腹腔积液的疗效。方法:对34例重症急性胰腺炎伴早期腹腔积液患者行床旁超声引导经皮腹腔穿刺置管引流,同时给予抑制胰酶、抑酸、抗感染、补液、营养支持等综合治疗;收集引流前后血清肿瘤坏死因子α(TNF-α)浓度、血清白介素6(IL-6)浓度、膀胱压、APACHE II评分、住院时间、并发症及病死率等,对其治疗结果进行分析。结果:34例经腹腔穿刺置管引流后病情均有不同程度的缓解,血清TNF-α,血清IL-6,膀胱压,APACHE II评分由穿刺引流前的(108.4±18.5)pg/mL,(32.4±9.8)pg/mL,(19.4±4.2)cmH2O,(17.6±4.2)降至引流5 d后的(86.6±14.8)pg/mL,(27.8±8.7)pg/mL,(12.7±3.4)cmH2O,(6.8±2.4);腹腔脓肿及胰腺假性囊肿为6例;病死3例,病死率为8.57%;住院时间为(26.7±11.8)d。结论:床旁超声引导经皮腹腔穿刺置管引流有助于重症急性胰腺炎降低腹内压、清除炎性介质、减少并发症、缩短住院时间,是一种微创、简便、安全、有效的方法。