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首页> 美国卫生研究院文献>World Journal of Gastroenterology >Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome
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Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

机译：重症急性胰腺炎腹腔综合征的连续区域动脉输注和腹腔镜减压

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AIM: To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion (CRAI) via a drug delivery system (DDS) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS).METHODS: We presented our recent experience in 8 patients with SAP. The patients developed clinical ACS, which required abdominal decompression. During the operation, a DDS was inserted into the peripancreatic artery (the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery). Through this DDS, a protease inhibitor, antibiotics and octreotide were infused continuously. The duration of the regional artery infusion ranged from 8 to 41 d. The outcomes and the changes in the APACHE II score, computed tomography (CT) severity index and intra-abdominal pressure (IAP) of the patients were retrospectively evaluated.RESULTS: Eight patients with an initial APACHE IIscore of 18.9 (range, 13-27) and a Balthazar CT severity index of 9.1 (range, 7-10) developed severe local and systemic complications. These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension (IAH). After a mean interval of 131.9 ± 72.3 d hospitalization, 7 patients recovered with decreased APACHE II scores, CT severity indexes and IAP. The mean APACHE II score was 5.4 (range, 4-8), the CT severity index was 2.3 (range, 1-3), and IAP decreased to 7.7 mmHg (range, 6-11 mmHg) 60 d after operation. One patient died of multiple organ failure 1 wk after surgery.CONCLUSION: CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.
机译：目的：通过药物输送系统（DDS）评估腹部减压加连续区域动脉输注（CRAI）对重症急性胰腺炎（SAP）腹腔室综合征（ACS）患者的治疗效果。方法：我们介绍了我们最近的经验SAP 8例。患者发展出临床ACS，需要腹部减压。在手术过程中，将DDS插入胰周动脉（将导管从右胃表皮动脉插入，直到到达胰十二指肠动脉与胃十二指肠动脉之间的连接处）。通过该DDS，可连续注入蛋白酶抑制剂，抗生素和奥曲肽。局部动脉灌注的持续时间为8到41 d。回顾性评估患者的APACHE II评分，计算机断层扫描（CT）严重程度指数和腹腔内压力（IAP）的结果和变化。结果：八名患者的APACHE II初始评分为18.9（范围13-27）。 ），Balthazar CT严重程度指数为9.1（范围7-10），出现了严重的局部和全身并发症。这些患者由于腹腔内高压（IAH）进行了随后的手术减压和CRAI治疗。在平均住院时间为131.9±72.3 d之后，有7例患者的APACHE II评分，CT严重度指数和IAP降低了，并且康复了。术后60 d APACHE II平均评分为5.4（范围4-8），CT严重度指数为2.3（范围1-3），IAP降至7.7 mmHg（范围6-11 mmHg）。一名患者在手术后1周死亡，死于多器官功能衰竭。结论：CRAI和腹腔减压术可能是SAP ACS患者的一种治疗选择。

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