中国急性胰腺炎诊治指南-2013年-上海-

ChinJGastroenterol2013Vol．18No.7··2013*中华医学会消化病学分会胰腺疾病学组中华胰腺病杂志编辑委员会中华消化杂志编辑委员会DOI10．3969/j．issn．1008-7125．2013．07．010*[e-mail]@[e-mail]。2003“”1AP。10APAP。AP。20%～30%5%～10%。、APAP20122AP。1．APMAPAP1～2。2．APMSAPAP48h48h。AP2。3．APSAPAP48h、、。SAP36%～50%3。4．①MSAP2003“”1“SAP”“SAP”。②“FAP”“72h”SIＲSAP。21．AP。CT。2．5%～10%AP。CT1CT。241．acuteperipancreaticfluidcollectionAPFC、。2．acutenecroticcollectionANC。3．、、AP4。4．walled-offnecrosisWON、、AP4。5．CT。、AP·824·2013187AP。1．、。AP5。≥11．30mmol/LAP＜5．65mmol/LAP6。2．、、、、、、、、、、、、、、、、α1-。EＲCP、AP。3．、。、AP1．、、、。BMI。2．、、、、、、。3．、、CEA、CA19-9、CT、EＲCPMＲCP、、、。、APAPAP、。SIＲS、。、。、、Grey-Turner、Cullen。。。。。APFC、ANC、、WON、、、、、、。AP2。、SIＲS、、IAHACS、PE。1．AP48h2MOF。AＲDS、、2。2．SIＲS2SIＲS。①＞90/min②＜36℃＞38℃③WBC＜4×109/L＞12×109/L④＞20/minpCO2＜32mmHg1mmHg=0．133kPa。SIＲS。3．SAP50%～80%。。4．IAHACSSAPIAHACS40%10%IAHSAPMODS7。UBPACSUBP≥20mmHg、、、、ACS8。5．PEAP、、、、AP。1．。。。、、、、。。·924·ChinJGastroenterol2013Vol．18No.7。。2．CＲP72hCＲP＞150mg/L。IL-6。AP。3．24～48hAPAP。CTAP1CT。SAPCT1。CTmodifiedCTseverityindexMCTSI90240≤30%2＞30%4、、2。≥4MSAPSAP。MＲIAP。AP1．AP32AP。①AP、、、②＞3③CT/MＲIAP。2．AP①MAPAP。、Ｒanson＜3APACHEⅡ＜8APBISAP＜3CTMCTSI＜4。②MSAPAP。Ｒanson≥3APACHEⅡ≥8BISAP≥3MCTSI≥4＜48h。、。③SAPAP。＞48hMarshall≥212。3．①AP、、、AP、、AＲDS。②APMAPSAP。。Ｒanson、APACHEⅡBMI＞28kg/m2、、72hCＲP＞150mg/L。APAP1。APCTMAPMSAPSAP1AP、APAP2。1．。、、、、、X。。24h。APACHEⅡ、Ｒanson、BISAP、CTBalthazarAP。SAP。、。、、。·034·20131871SAPMarshall01234PaO2/FiO2＞400301～400201～300101～200＜101mmHg＞90＜90＜90＜90pH＜7．3＜90pH＜7．2μmol/L＜134134～169170～310311～439＞439PaO2FiO221%、2L/min25%、4L/min30%、6～8L/min40%、9～10L/min50%APMAPMSAPSAPCTEＲCPESTEUS2AP2．①。10。。、0．9%NaCl。。②。SAP95%。AＲDS、。③。。continuousrenalreplacementtherapyCＲＲT≤0．5mL·kg－1·h－122SIＲS、PE。-continuousveno-venoushemofiltrationCVVHcontinuousplasmafiltrationadsorptionCPFA11。④。。SAP·134·ChinJGastroenterol2013Vol．18No.7、、、。。。3．EＲCP。H2。、AP、、AAP。4．MAP。MSAPSAP48h12。X。4．187J/mL。。。、、、、、、。、。5．1314AP。MAPMSAPSAP。、。“”、、。①②+β-③+④+。7～14d。。6．AP、、MAPEST。SAP48～72hEＲCPMAPEＲCP。APAP15。7．APFCANC16。WON＞6cm。1718。。8．SIＲS。CＲＲT、APSIＲS。、。SAPACS、、。9．、、、。、、。10．APACS1920。AP。11．。。、654-2Oddi·234·2013187。E1、SAP。SAP。执笔和整理者:王兴鹏，李兆申，袁耀宗，杜奕奇，曾悦参与修订者(以姓氏汉语拼音为序):陈旻湖，陈其奎，陈卫昌，杜奕奇，郭晓钟，郭学刚，郝建宇，冀明，贾林，金钢，黎介寿，李维勤，李晓燕，李延青，李兆申，廖专，刘俊，楼文晖，吕农华，钱家鸣，邵成伟，唐承薇，陶小红，田字彬，屠振兴，王兴鹏，谢渭芬，许建明，徐萍，袁耀宗，曾悦，湛先保，张圣道，张澍田，赵晓晏，邹晓平1．J．2004243190-192．2BanksPABollenTLDervenisCetal．Classificationofacutepancreatitis--2012revisionoftheAtlantaclassificationanddefinitionsbyinternationalconsensusJ．Gut2013621102-111．3VegeSSGardnerTBChariSTetal．LowmortalityandhighmorbidityinsevereacutepancreatitiswithoutorganfailureacaseforrevisingtheAtlantaclassificationtoinclude“moderatelysevereacutepancreatitis”J．AmJGastroenterol20091043710-715．4ZaheerASinghVKQureshiＲOetal．TherevisedAtlantaclassificationforacutepancreatitisupdatesinimagingterminologyandguidelinesJ．AbdomImaging2013381125-136．5BaiYLiuYJiaLetal．SevereacutepancreatitisinChinaetiologyandmortalityin1976patientsJ．Pancreas2007353232-237．6OhＲCLanierJB．ManagementofhypertriglyceridemiaJ．AmFamPhysician20077591365-1371．7KeLNiHBTongZHetal．Intra-abdominalpressureandabdominalperfusionpressurewhichisabettermarkerofseverityinpatientswithsevereacutepancreatitisJ．JGastrointestSurg20111581426-1432．8．J．20074511727-729．9BollenTLSinghVKMaurerＲetal．ComparativeevaluationofthemodifiedCTseverityindexandCTseverityindexinassessingseverityofacutepancreatitisJ．AJＲAmJＲoentgenol20111972386-392．10FisherJMGardnerTB．The“goldenhours”ofmanagementinacutepancreatitisJ．AmJGastroenterol201210781146-1150．11HeCZhangLShiWetal．Coupledplasmafiltrationadsorptioncombinedwithcontinuousveno-venoushemofiltrationtreatmentinpatientswithsevereacutepancreatitisJ．JClinGastroenterol201347162-68．12MirtalloJMForbesAMcClaveSAetal．InternationalconsensusguidelinesfornutritiontherapyinpancreatitisJ．JPENJParenterEnteralNutr2012363284-291．13BesselinkMGvanSantvoortHCBuskensEetal．Probioticprophylaxisinpredictedsevereacutepancreatitisarandomiseddouble-blindplacebo-controlledtrialJ．Lancet20083719613651-659．14VillatoroEMullaMLarvinM．AntibiotictherapyforprophylaxisagainstinfectionofpancreaticnecrosisinacutepancreatitisJ．CochraneDatabaseSystＲev20105CD002941．15vanBaalMCBesselinkMGBakkerOJetal．TimingofcholecystectomyaftermildbiliarypancreatitisasystematicreviewJ．AnnSurg20122555860-866．16．J．2012329577-579．17．1064J．2012126366-370．18．1033J．200947191472-1474．19BabuＲYGuptaＲKangMetal．Predictorsofsurgeryinpatientswithsevereacutepancreatitismanagedbythestep-upapproachJ．AnnSurg20132574737-750．20FreemanMLWernerJvanSantvoortHCetal．InterventionsfornecrotizingpancreatitissummaryofamultidisciplinaryconsensusconferenceJ．Pancreas20124181176-1194．2013-05-31·334·