| Objective: Through clinical observation, data collection, sorting the data andretrospective analysis of the clinical data of47cases of non biliogenic severeacute pancreatitis patients of pancreaticobiliary ward two of surgical center ofGeneral Hospital of Chengdu Military Region,to learn the clinical effect and itspossible mechanism of ultrasound guided percutaneous catheter drainage in thetreatment of non biliogenic severe acute pancreatitis patients with pancreaticnecrosis, acute peripancreatic fluid accumulation, peripancreatic necrosis,peripancreatic abscess and pancreatic abscess as early as possible, to provideobjective evidence for early clinical treatment and control of the disease.Methods: Patients diagnosed with non biliogenic severe acute pancreatitis andhospitalized in2012.1-2013.1,according to the inclusion criteria and exclusioncriteria, a total of47patients were screened, according to the observationcondition first divided into A, B two groups, group C were screened in A group.RANSON score, CT score, APACHE-Ⅱscore completes by multipledepartment cooperation, records of biochemical data, the remission ofsymptoms and control, special treatment, hospitalization, complications andfollow-up results to date.Results:(1) Evaluation of severity score when patients admitted: RANSONscore, CT score, APACHE-Ⅱ s core of A group were4.1±1.55(3-6),2.80±1.47(4-8),5.95±4.40(6-13), B group were4.80±1.44(4-6),3.05±1.85(4-8),8.45±6.23(4-24), the two group’s corresponding data were analysed byOne-Way ANOVA and P values were0.639,0.147,0.151, no significantdifference; C-reactive protein (CRP) in A group was99.75±99.44mg/L, Bgroup was144.86±100.71mg/L, t test P=0.55, there was no significant difference in admission drop; procalcitonin>0.05ng/L in A group was(0.05-23.11ng/L), B group was (0.08-67.1ng/L), from the above data, we canthink of A group’s severity as the same of B group’s at the time of admission.(2)the treatment results: in A group, the fully conservative treatment wassuccessful in16cases,11cases of Agroup undergone ultrasound guidedpercutaneous catheter drainage when conservative treatment can not improvethe patient abdominal signs and intra-abdominal hypertension induced renaldysfunction and respiratory distress, and the11cases classified as group C,4cases of pancreatic pseudocyst; in the20cases in group B,2cases were wasingravescence and dead at the ninth day after admission because of illnesscontinue to secondary aggravated after rescue,1cases of pancreatic pseudocyst,successful treatment of18cases. The hospitalization days of group A was14±8.9d (15-30d), B group38.7±36.9d(9-93days), group C was33.7±26d(28-121d), number of days for analysis of variance obtained P=0.113hospital,the hospital stay was not significantly different.3cases in C group (3/11) and3cases in B group (3/20) with necrotic pancreatic tissue infection, when thedrainage tube sinus tract formated mature, udergone necrotic tissue dissectionthrough the sinus by biliary endoscopic (6-10times, average2times/week),6cases were cured. A total of31patients underwent ultrasound guidedpercutaneous catheter, drainage tube at least1(only1cases), up to5, the firstpuncture drainage fluid undergone smear and culture were not found the growthof bacteria, bacterial culture results of post drainage fluid for4cases ofBauman Acinetobacter,2cases of Enterococcus faecium D group,2cases wereEscherichia coli,1cases of Staphylococcus aureus, and the drainage fluidculture in3cases of the above9cases as the same of blood culture, the infectionrate was29%(9/31). Body fluid culture of fungal infection in2cases ofsuspected. B groups in the hospital24hours perfecting CT and ultrasoundguided percutaneous catheter drainage, and patients in group C puncture time is4-7days after admission. In47patients,5patients suffered from acute renal failure, after consultation of the nephrology department,3patients underwentCRRT treatment;10cases with ARDS,6cases of noninvasive ventilatorassisted breathing,4cases of tracheal intubation.13cases in A group (13/27)need long time use of analgesic drugs for pain control, and only2case in Bgroup (2/20),10cases of C group use of analgesic drugs in short term.Conclusion:(1) Ultrasound guided catheter drainage with the advantages ofminimally invasive, simple, good tolerance, easy to accept; is a effectivemeasures for treatment of severe acute pancreatic disease and complications.(2)In the early treatment of severe acute pancreatitis, ultrasound guided puncturewith early drainage peripancreatic effusion can effectively improve theintra-abdominal pressure and effectively relieve symptoms and signs of patients.(3) In the late stage treatment of severe acute pancreatitis, the ultrasound guidedcatheter drainage and replace drainage tubes are effective method for thetreatment of regional fluid accumulation, peripancreatic necrosis, pancreaticnecrosis, peripancreatic abscess and pancreatic abscess.(4) Ultrasound guidedpercutaneous catheter drainage also exist the risk and complications associatedwith site of puncture, puncture, puncture path. |
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