| The first partObjective To investigate the safety and accuracy of percutaneous catheter drainage(PCD)in the treatment of severe acute pancreatitis(SAP)with CT and ultrasound different positioning methods.Methods Retrospective analysis and summary of 50 patients with SAP in Emergency Department of the Second Affiliated Hospital of Anhui Medical University from June2014 to June 2016.Among them,25 patients underwent percutaneous catheter drainage under CT positioning as CT group,Ultrasound localization was performed in 25 patients who underwent percutaneous catheter and the same diameter was used as the ultrasound group,the differences in treatment safety and accuracy between the two groups were analyzed.Results The CT group and the ultrasound group were compared in terms of age,gender,onset time and etiology,there was no significant difference between the two groups(P>0.05);the white blood cell count,platelet count,and blood amylase before and after catheterization were performed in the two groups,the difference was no significant between lipase and blood glucose(P>0.05);there was no significant difference in SIRS score,APACHE II score and SOFA score between the two groups(P>0.05);CT group the incidence of bleeding and adjacent organ injury in the complications was significantly lower than that in the ultrasound group,the difference was statistically significant between the two groups(P<0.05);the time and the one-time success rate and the ultrasound group were completed in the CT group,the former was shorter,the success rate of one-time puncture was higher,and the difference between the two groups was significant(P<0.05).Conclusions Compared with ultrasound positioning,CT positioning and PCD treatment of SAP have advantages in terms of safety and accuracy.Second partObjective To investigate the therapeutic effect of percutaneous puncture with different diameters of drainage tube on SAP under CT positioning.Methods Collecting and summarizing 36 cases of SAP patients treated with PCD treated by Emergency Department of the Second Affiliated Hospital of Anhui Medical University from October 2015 to October 2017,18 of them underwent percutaneous puncture into the thick tube under CT positioning(21-30Fr)the drainage lavage was treated in the observation group,and the other 18 patients underwent percutaneous puncture and placement of a thin tube(10-20Fr)under CT placement as a control group.The disappearance time of abdominal pain after catheterization was compared between the two groups,the time of bloating disappeared,the white blood cell count returned to normal time,the platelet count returned to normal time,the blood amylase returned to normal time,the lipase returned to normal time,the blood glucose returned to normal time,the hospital stay and inflammation response degree of recovery.Results The time it took abdominal pain to disappear after treatment in the observation group and the control group was(3.74 ± 1.11,5.27 ± 1.21)d,the disappearance time of abdominal distension was(8.87±1.37,11.42±1.69)d,and the normal time of white blood cell recovery was(7.78± 0.81,11.47±1.34)d,the normal time of platelet count recovery was(6.93±0.88,8.15±1.59)d,and the normal time of blood amylase recovery was(6.23 ± 0.71,7.71 ± 0.58)d,and the lipase returned to normal time.The difference was(8.21±0.83,10.28±0.93)d,and the difference was statistically significant between the observation group and the control group(P<0.05);the total hospitalization days of the observation group and the control group were(17.93 ± 0.51,18.09 ± 0.74)d,respectively,the normal time of blood glucose recovery was(10.44±1.11,10.09±0.89)d,there was no significant difference between the two groups(P>0.05);the SIRS scores of the observation group and the control group were better than 1 week after the catheterization,before the catheterization,the difference was statistically significant(P<0.05);and the SIRS score was lower and the reduction was larger after 1 week of the treatment with the thin tube,the difference was statistically significant between the two groups(P < 0.05).Conclusions CT placemennt of the thicker drainage tube than the placement of the thin drainage tube can improve the clinical indicators of SAP patients more quickly,effectively reduce the degree of inflammation response,and has a crucial clinical value for improving the efficacy of SAP.Third partObjective To explore the clinical application value of constant temperature lavage fluid in SAP peritoneal lavage.Methods Collect and summarize 45 cases of SAP in the Emergency Department of the Second Affiliated Hospital of Anhui Medical University from August 2016 to August 2018,21 of which were heated by a constant temperature heater(temperature stabilized at 37°C)and then treated with constant temperature peritoneal lavage as a constant temperature,in the group,24 patients with SAP treated with room temperature peritoneal lavage at the same time as the room temperature group,compared and analyzed the APACHE II score,the incidence of related complications,abdominal pain disappears,abdominal distension disappearance time and length of hospital stay in the two groups after treatment with two different temperature lavage fluids.Results The APACHE II score,the proportion of complicated intestinal fistula,the proportion of chills,the proportion of new renal dysfunction,the proportion of new-onset gastric dysfunction,and the length of hospital stay in the constant-temperature peritoneal lavage group were compared with the room temperature peritoneal lavage group,the difference is obvious,statistically significant(P<0.05).Conclusions Constant temperature peritoneal lavage is of great significance for improving the severity of SAP patients,shortening hospital stay,reducing complications and improving prognosis. |
PDF Full Text Request