Objective To evaluate the effectiveness of enteral immunonutrition for patients with acute pancreatitis. Methods The randomized controlled trials (RCTs) about enteral immunonutrition for patients with acute pancreatitis were searched in following databases: PubMed (1966 to August 2012), MEDLINE (Ovid, 1946 to August 2012), CENTRAL (Issue 3, 2012), CBM (1978 to August 2012), CNKI (1979 August 2012), VIP (1989 to August 2012), and WanFang Data (1977 to August 2012). The relevant materials and each reference of literature were also searched manually. Two reviewers independently screened the literature according to the predefined inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 197 patients were included. The results of meta-analysis showed that there were no significant differences between the enteral immunonutrition group and the routine enteral nutrition group in following aspects: infectious complications and mortality rate, length of stay, level of C-reactive protein and numeration of leucocyte after treatment, and APACHE II score. Conclusion At present, no evidence shows enteral immunutrition is superior to routine enteral nutrition in acute pancreatitis. For the quantity and quality limitation of the included studies, more high-quality and large-sample RCTs are required to investigate the proper ingredients and dosage of enteral immunonutrition suitable for patients with acute pancreatitis.
Objective To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis (SAP). Methods Such databases as MEDLINE, EMbase, CENTRAL, VIP, WanFang Data, CBM and CNKI were electronically searched from inception to October, 2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2. Results Five trials were included involving a total of 227 patients. The results of meta-analysis showed that: compared with the control group, the alanyl-glutamine dipeptide group had the lower incidence of SAP complications (RR=0.41, 95%CI 0.20 to 0.82), the lower incidence of infected pancreatic necrosis (RR=0.12, 95%CI 0.02 to 0.89), less time for alleviating bellyache (MD= –0.90, 95%CI –1.72 to –0.08). There was a tendency in decreasing SAP mortality (RR=0.15, 95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase (SMD=0.37, 95%CI –0.04 to 0.79). Conclusion Current evidence shows that, alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis, and shorten the time for alleviating bellyache in SAP patients. Due to the limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
【摘要】 目的 评价生长抑素联合中药在治疗重症急性胰腺炎中的有效性。 方法 应用国际Cochrane协作网系统评价方法对生长抑素联合中药治疗重症急性胰腺炎的随机对照试验（RCT）进行系统评价。计算机检索MEDLINE（Ovid）、PubMed数据库、中文科技期全文数据库（VIP）、万方数据库、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）。检索时间均为建库至2009年9月。文献检索语种为英语和中文。 结果 共纳入8个RCT，436例患者，所有纳入试验在治疗末均未进行随访。Meta分析结果显示，生长抑素联合中药治疗组（治疗组）的病死率（13/188，6.9%）明显低于单纯生长抑素治疗组（对照组）（24/174，13.7%），差异有统计学意义[Peto OR=0.46，95%CI（0.22，0.94），Plt;0.05]。治疗组平均住院日低于对照组[WMD=-7.01，95%CI（-7.89，-6.13），Plt;0.000 01]。治疗组腹痛缓解时间明显低于对照组，其差异有统计学意义[WMD=-0.77，95%CI（-0.82，-0.72），Plt;0.000 01]。治疗组与对照组治疗第7天APACHE Ⅱ评分均下降，治疗组下降幅度大于对照组，两组比较差异有统计学意义（Plt;0.05）。治疗组并发症发生率（26/91，28.6%）与对照组（35/88，39.8%）相比，其差异无统计学意义[Peto OR=0.61，95%CI（0.32，1.13），P=0.12]。 结论 生长抑素联合中药治疗在改善重症急性胰腺炎的病死率、平均住院时间、腹痛缓解时间、APACHE Ⅱ评分下降幅度优于单纯生长抑素治疗。
【摘要】 目的 利用首过时间技术进行全胰腺CT灌注扫描，了解正常胰腺CT灌注的特点。 方法 2006年6月-2007年3月， 64例正常胰腺患者行64排螺旋CT灌注扫描，测量胰头、胰体及胰尾的灌注值、强化峰值、达峰时间和血容量。分别按患者的性别、年龄及胰腺测量的部位分组，将灌注参数进行统计分析。 结果 ①男性胰腺的血容量高于女性（Plt;0.05），其余灌注参数在两性间差异无统计学意义（Pgt;0.05）。②41~60岁组的灌注值低于lt;40岁组和gt;60岁组；gt;60岁组的强化峰值高于41~60岁组；41~60岁组的达峰时间长于lt;40岁组；gt;60岁组的血容量高于41~60岁组（Plt;0.05）。③胰体和胰尾的灌注值高于胰头（Plt;0.05），其余灌注参数在胰腺不同部位差异无统计学意义。 结论 正常胰腺血流状况在不同性别、不同年龄段及不同部位存在差异，首过时间技术应用于正常胰腺能反映这些特征。【Abstract】 Objective To investigate the CT perfusion features of normal pancreas with first-pass technique with 64-MDCT. Methods Perfusion CT was performed on 64 patients with normal pancreas from June 2006 to March 2007. Four perfusion parameters, including perfusion, peak enhancement, time to peak, and blood volume, were obtained at the head, body and tail of the pancreas. Perfusion parameters were compared between different sexes, among different age groups and among different sites. Results ① Blood volume of male was significantly higher than that of female (Plt;0.05). ② The perfusion value in the age group of 41-60 was significantly lower than that in the age group of lt;40 and gt;60 (Plt;0.05). The peak enhancement in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). The time to peak in the age group of 41-60 was significantly longer than that in the age group of lt;40 (Plt;0.05). The blood volume in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). ③The perfusion values of the body and the tail were significantly higher than that of the head (Plt;0.05). Conclusion There are significant differences in the perfusion parameters between different sexes and among several age groups and sites. The first-pass technique of perfusion applied in normal pancreas can reflect these features.
【摘要】 目的 探讨比较全肠内营养支持和全肠外营养支持对急性重症胰腺炎（severe acute pamcreattis，SAP）预后的影响。 方法 将2003年1月-2008年12月收治的54例SAP患者于入院后第1周内随机分为两组:全肠内营养（A）组27例；全肠外营养（B）组27例。两组患者均静脉给予广谱抗生素预防感染。入院时CT扫描及C反应蛋白水平显示两组患者具有可比性。 结果 B组22例患者发生器官衰竭，明显高于A组（5例）。B组22例患者接受了手术治疗，A组手术患者6例（Plt;0.05）。A组患者胰腺坏死后感染发生率明显低于B组（Plt;0.05）。B组患者死亡率高于A组（Plt;0.05）。 结论 全肠内营养支持，不仅可以促进肠道功能的恢复和营养状况的维持，还可减少肠源性感染的发生率，对减少SAP的感染性并发症和病死率具有积极作用。【Abstract】 Objective To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP). Methods A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups. Results Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05). Conclusion Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.
目的：观察柴芩承气汤治疗重症急性胰腺炎(SAP)并发麻痹性肠梗阻 (Paralytic Intestinal Obstruction)的疗效。方法:依据纳入和排除标准,选取四川大学华西医院中西医结合科收治的SAP患者40例,按1∶1比例随机分成试验组(20例)和对照组(20例),试验组入院时即给予柴芩承气汤灌肠治疗,对照组使用安慰剂灌肠治疗;两组入院时基线资料差异无统计学意义(Pgt;005)，且两组均给予相同常规西医治疗。观察入院后其首次自行排便排气时间,入院时、入院后第3天、第7天APACHEⅡ评分及住院病程。结果:入院后首次自行排便排气时间试验组（302±154）天,低于对照组（453±241）天;入院后第3天APACHEⅡ评分试验组（925±184）分，低于对照组（1163±222）分;入院后第7天APACHEⅡ评分试验组（624±247）分，低于对照组（881±325）分。住院时间试验组（2453±426）天,低于对照组（3032±589）天。结论:早期应用柴芩承气汤灌肠治疗SAP并发麻痹性肠梗阻,可缩短麻痹性肠梗阻的持续时间及减轻其危害,减少住院病程。
目的:探讨急性胰腺炎(AP)并发胰腺假性囊肿(PPC)的早期诊断、早期治疗方法及疗效观察。方法:急性胰腺炎患者给予常规治疗,每周复查B型超声,必要时复查上腹部CT,一旦检查诊断为胰腺假性囊肿形成,即给予TDP(CQ型特定电磁波治疗器)烤腹部相应囊肿部位皮肤,烤后再以适量黄冰解毒消肿软膏外敷腹部相应囊肿部位皮肤,每周复查B超1次,直致囊肿消失。结果: 63例胰腺假性囊肿56例胰腺假性囊肿经保守治疗后完全消失,有效率8889%(56/63),平均68周时间,最短时间2周,最长时间12周。7例囊肿未消失,其中2例囊肿有缩小,5例无效。结论: 胰腺假性囊肿形成早期诊断,早期联合物理治疗和中药外敷疗效显著,不失为一种安全、有效、经济的治疗方法。
摘要:目的：探讨急性重症胰腺炎（SAP）早期不同种类液体复苏对其预后的影响。方法：应用随机对照的方法,分别对2007年12月~2009年10月同期入院的48例SAP患者,随机分成两组,试验组和对照组。试验组第一周内液体复苏采用晶体液和人工胶体（羟乙基淀粉）,对照组采用晶体液,其他治疗方法不变。然后统计其第一周死亡率、ARDS、多器官功能障碍综合征（MODS）发生率,对比两组患者呼吸频率、血氧饱和度和红细胞压积（HCT）差异,以及两组患者肠功能恢复时间、住院时间以及并发症发生率。结果：试验组的液体复苏较对照组显著改善SAP的各项指标（P＜005）。血清乳酸水平（15±05）mmol/L,红细胞压积(HCT)为（324±69）%,ScvO2为（817±152）%,病死率83%,MODS发生率333%,〖HT5”H〗结论:〖HT5”SS〗 SAP早期联合应用晶胶体进行液体复苏可有效恢复循环血容量和防止体液潴留,显著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.