急性胰腺炎诊治指南_2014

（）2015492ChinArchGenSurg（ElectronicEdition），April2015，Vol．9，No．2DOI:10.3877/cma.j.issn.1674-0793.2015.02.002:,Email:[e-mail]··2000《》,2004,,2006《》,11,2007。,。,、、,《》。《(2014)》,,。、()(acutepancreatitis,AP),,(systemicinflammatoryresponsesyndrome,SIRS)。(),,。,、,(Grey-Turner)(Cullen)。。,。CTAP,BalthazarCT(1)、CT(modifiedCTseverityindex,MCTSI)(2)。B。()32:(1)AP;(2)()3;(3)AP。、AP()1.(interstitialedematouspancreatitis):AP/,CT,,。(2014)CTABCDEBalthazarCT,,,,、,,1BalthazarCT:MRICT()≤30%30%,、、02402422MCTSI:MCTSI86··（）2015492ChinArchGenSurg（ElectronicEdition），April2015，Vol．9，No．22.(necrotizingpancreatitis):AP()。,CT,1CT。()1.(mildacutepancreatitis,MAP):AP,,1~2,。2.(moderatelysevereacutepancreatitis,MSAP):(48h)。,,。3.(severelyacutepancreatitis,SAP):AP5%~10%,(48h)。SAP,。Marshall,≥2(3)。、1.():2,SIRS,1,、。2.():24,。,。。3.():4,、、,、。2,。、()AP,SIRS、(sepsis)、(multipleorgandysfunctionsyndrome,MODS)、(multipleorganfailure,MOF)(abdominalcompartmentsyndrome,ACS)。()1.(acuteperipancreaticfluidcollection,APFC):,,,。2.(acutenecroticcollection,ANC):,,。3.(walled-offnecrosis,WON):(),AP4。(PaO2/FiO2)a(,μmol/L)(,mg/dl)(,mmHg)b,FiO2:(L/min)246~89~100400≤134≤1.490FiO2(%)21253040501301~400134~1691.4~1.890,2201~300170~3101.9~3.690,3101~200311~4393.6~4.990,pH7.34≤1014394.990,pH7.2:a,134μmol/L1.4mg/dl;b3Marshall87··（）2015492ChinArchGenSurg（ElectronicEdition），April2015，Vol．9，No．24.(pancreaticpseudocyst):,4,。、()1.AP:AP,,。AP,;。2.AP:AP11.3mmol/L,,5.65mmol/L。,。,。3.:,。、、。()1.:、,、、,。2.:、,SIRS(capillaryleaksyndrome,CLS),,。,。,CVP/PWCP、HR、、、HCT。3.:(1):,95%,,。(2):,;(continuousrenalreplacementtherapy,CRRT)。(3):,H2。4.:,;,。,、、,。5.:AP。(、、),:、、。6.:,、。()SAPACS,(intra-abdomi-nalpressure,IAP)20mmHg(1mmHg=0.133kPa),SAP。IAP、,,0,,50ml,IAP。ACSIAP,、、,BCT。APACS。(),、,、、。。1./:,CT,,,。,,,。BCT(percutaneouscatheterdrainage,PCD)/,,。,、。88··（）2015492ChinArchGenSurg（ElectronicEdition），April2015，Vol．9，No．22./:PCD、、。、(、)。。,,。,。3.:(1)APFCANC:,。,,,,BCTPCD,。(2)WON:WON,,。,PCD。(3):WON,,;。,。4.:、、。。,,()。。。AP,,。,。：：：：，，（）：，，，，，，，，，，，，，，，，，，，，，，，，，，，，，，.[J].,2007,45(11):727-729..[J].,2007,45(11):721.BanksPA,BollenTL,DervenisC,etal.Classificationofacutepancreatitis-2012:revisionoftheAtlantaclassificationanddefi-nitionsbyinternationalconsensus[J].Gut,2013,62:102-111.WorkingGroupIAP/APAAcutePancreatitisGuidelines.IAP/APAevidence-basedguidelinesforthemanagementofacutepan-creatitis[J].Pancreatology,2013,13(4Suppl2):e1-15.PezzilliR,ZerbiA,DiCarloV,etal.Practicalguidelinesforacutepancreatitis[J].Pancreatology,2010,10(5):523-535.HartwigW,MaksanSM,FoitzikT,etal.Reductioninmortalitywithdelayedsurgicaltherapyofseverepancreatitis[J].JGas-trointestSurg,2002,6(3):481-487.vanSantvoortHC,BesselinkMG,BakkerOJ,etal.Astep-upapproachoropennecrosectomyfornecrotizingpancreatitis[J].NEnglJMed,2010,362(16):1491-1502.KirkpatrickAW,RobertsDJ,DeWaeleJ,etal.Intra-abdominalhypertensionandtheabdominalcompartmentsyndrome:updatedconsensusdefinitionsandclinicalpracticeguidelinesfromtheWorldSocietyoftheAbdominalCompartmentSyndrome[J].Inten-siveCareMed,2013,39(7):1190-1206.VanSantvoortHC,BakkerOJ,BollenTL,etal.Aconservativeandminimallyinvasiveapproachtonecrotizingpancreatitisim-provesoutcome[J].Gastroenterology,2011,141(4):1254-1263.WittauM,MayerB,ScheeleJ,etal.Systematicreviewandmeta-analysisofantibioticprophylaxisinsevereacutepancreatitis[J].ScandJGastroenterol,2010,46(3):267-270.HorvathK,FreenyP,EscallonJ,etal.Safetyandefficacyofvideo-assistedretroperitonealdebridementforinfectedpancreaticcollections:amulticenter,prospective,single-armphase2study[J].ArchSurg,2010,145(9):817-825.BabuRY,GuptaR,KangM,etal.Predictorsofsurgeryinpa-tientswithsevereacutepancreatitismanagedbythestep-upap-proach[J].AnnSurg,2013,257(4):737-750.(:2015-03-12)123456789101112.(2014)[J/CD].:,2015,9(2):86-89.89··