. The normal value of serum amylase is 40 to 110U (Somogyi). If it exceeds 500u, it indicates acute pancreatitis. However, in 1/3 to 2/3 cases of acute pancreatitis, the serum amylase can be below 500u. Especially in severe pancreatitis, the serum amylase can be Within the normal range, serum amylase often increases within 2 to 12 hours after the onset of the disease, and returns to normal after 48 to 72 hours. At this time, urinary amylase should be measured. It is best to measure the total amount of amylase in urine for two hours. When the urinary amylase exceeds 300u per hour, the accuracy of diagnosis can be doubled.
Most acute pancreatitis is mild acute pancreatitis and can be cured with active treatment within 3 to 5 days. Treatment measures: ① fasting; ② gastrointestinal decompression; ③ intravenous infusion, actively replenish blood volume, maintain water, electrolyte and acid-base balance, and pay attention to maintaining heat energy supply; ④ analgesic treatment: pethidine can be given to patients with severe abdominal pain; ⑤ antibiotics : Since acute pancreatitis is a chemical inflammation, antibiotics are not necessary; however, acute pancreatitis in my country is often related to biliary tract disease, so it is used clinically; if combined infection is suspected, 1 to 2 antibiotics must be used; ⑥Acid suppression Treatment: In the past, routine application was emphasized, but currently clinical application is still customary; if used (intravenous administration of H2 receptor antagonists or proton pump inhibitors), it can prevent stress ulcers.
Severe pancreatitis must take comprehensive measures and actively rescue and treat. In addition to the above treatment measures, the following should also be included:
1. Medical treatment
(1) Monitoring such as If possible, the patient should be transferred to the intensive care unit (ICU). Take appropriate measures against organ failure and metabolic disorders. For example, closely monitor blood pressure, blood oxygen, urine output, etc.;
(2) Maintain water and electrolyte balance, maintain blood volume, and actively replenish fluids and electrolytes (potassium, sodium, calcium, magnesium, etc.) to maintain effective blood volume. Severe patients often suffer from shock and should be given albumin, blood or plasma substitutes.
(3) Nutritional support is particularly important for patients with severe pancreatitis. Total parenteral nutrition (TPN) is generally used in the early stage; if there is no intestinal obstruction, jejunal intubation should be performed as soon as possible to transition to enteral nutrition (EN). Nutritional support can strengthen the intestinal mucosal barrier and prevent intestinal bacterial translocation from causing pancreatic necrosis and infection.
(4) Antimicrobial drugs Routine use of antibiotics in severe pancreatitis can prevent pancreatic necrosis and infection. The selection of antibiotics should consider: ① Antibiotics that are sensitive to intestinal translocated bacteria (Escherichia coli, Pseudomonas, Staphylococcus aureus, etc.); ② Antibiotics with good permeability to the pancreas: such as imipenem or quinolone etc., and combined with drugs that are effective against anaerobic bacteria (such as metronidazole). Second- and third-generation cephalosporins can also be considered.
(5) Reduce pancreatic juice secretion Somatostatin has the effect of inhibiting the secretion of pancreatic juice and pancreatic enzymes and inhibiting the synthesis of pancreatic enzymes. Somatostatin and its analogue octapeptide (octreotide) are more effective. They can also relieve abdominal pain, reduce local complications, and shorten the length of hospitalization. The first dose is 100 μg intravenously, followed by continuous intravenous infusion of somatostatin/octreotide 250 μg/25-50 μg every hour for 3-7 days. Although the efficacy has not yet been determined, domestic scholars currently recommend its early use.
(6) Inhibiting pancreatic enzyme activity is only used in the early stages of severe pancreatitis, but the efficacy has yet to be confirmed. Aprotinin can resist pancreatic bradykinin, preventing probradykinin from changing into bradykinin. It can also inhibit protease, chymotrypsin and serotonin. 200,000 to 500,000 U/d, dissolved in 2 times Intravenous infusion of glucose solution; fluorouracil can inhibit DNA and RNA synthesis, reduce pancreatic juice secretion, and inhibit phospholipase A2 and trypsin. 500 mg per day, add 5 ml of glucose solution for intravenous infusion.
Gabexate (FOY, gabexate) can inhibit protease, bradylin, prothrombin, elastase, etc. According to the condition, start taking 100 to 300 mg per day dissolved in 500 to 1500 ml of glucose saline, at 2.5 mg/(kg.h ) speed drip. The condition improves in 2 to 3 days and the dosage can be gradually reduced.
2. Endoscopic Oddi sphincterotomy (EST) can be used for emergency decompression, drainage and removal of gallstone obstruction in the biliary tract as a non-surgical therapy for biliary pancreatitis. and prevent the development of pancreatitis. It is suitable for elderly people who are not suitable for surgery and must be performed by experienced endoscopists.
3. Traditional Chinese medicine has certain curative effect on acute pancreatitis. Mainly include: Bupleurum, Coptis, Astragalus, Citrus aurantium, Magnolia officinalis, Acostalis, white peony root, Glauber's salt, rhubarb (below), etc., which can be added or subtracted according to the disease.
IV. Surgical treatment
(1) Peritoneal lavage. Abdominal lavage can remove bacteria, endotoxins, pancreatic enzymes, inflammatory factors, etc. in the abdominal cavity and reduce the entry of these substances into the blood circulation. Later, damage to organs throughout the body.
(2) The indications for surgery are: ① When the diagnosis is not clear and it is difficult to distinguish from other acute abdominal diseases such as gastrointestinal perforation; ② Severe pancreatitis that fails medical treatment; ③ Pancreatitis complicated by abscess, pseudocyst Cysts, diffuse peritonitis, intestinal paralysis and necrosis; ④ When biliary pancreatitis is in an acute state and requires surgery to relieve obstruction.