| Objective To study the severe acute pancreatitis (SAP) in the natural course of evolution of organ function and clinical characteristics of deaths. Four diagnostic methods of Chinese medicine is based on the dialectic through six-channel dialectical SAP the syndromes preach change stage. And study the clinical characteristics and related factors of the secondary infection of severe acute pancreatitis and bacterial spectrum and antibiotic resistance. Evaluate therapeutic efficiency of TongLiGongXia treatments for severe acute pancreatitis. Reserch the Qingyi tablets on patients with severe acute pancreatitis recovery of long-term therapeutic value.Methods Retrospective analysis from January1999to December2008treated346cases of severe acute pancreatitis cases, in accordance with the admission,1,3,5,7,14and28days a total of seven time points APACHEII score were recorded, the state organ and attack time, at the same time, deputy director of Chinese medicine physicians from four diagnostic methods for evaluation, and then based on the six-channel by the dialectical theory of syndrome differentiation. SAP will be48cases of hospital deaths by24h,24-72h,3-10days and10days after the group discussions in four time the cause of death, disease physiological characteristics. The279cases of severe acute pancreatitis patients were systematic analysised by the clinical indicators. Be divided into87cases of infection and192cases of non-infection group. Clinical and laboratory examination of20single-factor analysis of indicators. With65cases of pancreatic infection in patients with dynamic blood, pancreatic necrosis and peripancreatic fluid bacterial culture, identification and drug sensitivity test.Results In severe acute pancreatitis natural progression APACHEII score a double-peak type distribution, Early and adanced phase, the most affected organs are the respiratory, peripheral circulation, kidney and gastrointestinal tract. However, early phase organ failure caused by SIRS, advanced phase caused by the infection. Organ failure in patients with early complications for the SIRS, metabolic acidosis, high blood sugar, high-pressure abdominal cavity. Sustained over48hours significantly increased mortality of organ failure. Died24h after admission in5cases (10.4%), mainly for the serious shock, cardiac arrest;24-72h of death in7cases (14.7%),For the continuity of the main shock with ARDS or acute renal failure;3-10days of the death of16cases (33.3%), mainly for ARDS, acute renal failure associated with MOF;10days after the death of20cases (41.7%), mainly bleeding, pancreatic biliary fistula, caused by secondary infection, such as MOF. The duration of intestinal paralysis in patients with more than five days incidence of organ failure, infection rates increased significantly.Early in the SAP of TCM dialectical, tongue and dry for moss yellow veins, pulse string. Adanced TCM syndrome differentiation ChiCheng hot for poison gas, with the disease, the blood with camp, hot and astringing reality. For Jiang tongue veins is swollen, dry tongue very black, or smoldering form since no moss. Since the moss, or a large number of pulse float, or heavy number, or sink, or confusion. See more medicine dialectical convalescence qi and Yin, tongue is red tongue pulse, moss, or a little and thin and crack. Pancreatic or peripancreatic infections occurred in the incidence of more than two weeks or two weeks later. The related factors of infection was hypoxemia, intestinal paralysis, APACHE-â…¡ score, TPN, early surgery, intraperitoneal drainage, the degree of pancreatic necrosis. The initial65cases of patients with positive bacterial culture occurred in the incidence of more than2to3weeks (76.5%) occur; infection for the composite bacterial infection, mainly in Gram-negative; of gram-negative bacteria mainly for drug-sensitive subamine Peinan, cefoperazone sulbactam; against Gram-positive bacteria sensitive to the drugs mainly imipenem, vancomycin and so on. Chinese medicine treatment group standardized mean difference of first defecation time and days of hospitalization, was significantly lower than the control group and there was a significant difference (SMD=-2.34, P<0.01; SMD=-1.91, P<0.01). Chinese medicine treatment group OR affiliate of operability, complication rate, mortality was significantly lower than the control group and there was a significant difference (OR=0.36, P<0.01; OR=0.41,P<0.01; OR=0.31, P<0.01). Patients with severe acute pancreatitis discharged one year AP recurrence rate was46.3%(126/272). The AP recurrence rate of of the Chinese Herb group was39.9%within discharged one year, decreased significantly from the control group. After discharge from hospital6months and1year, Chinese herb group improved nutritional status significantly than the control group. Conclusion:The severe acute pancreatitis is divided into the early period and the recovery progress.It was an affecting important factor that intestinal paralysis on the natural course of SAP. The most affected organ failure was respiratory organ, peripheral circulation, kidney and gastrointestinal tract. Organ failure in patients with early complications for the first time include SIRS, metabolic acidosis, high blood sugar, high-pressure abdominal cavity. SIRS-induced MOF is the early death of SAP factors; pancreatic infection, intra-abdominal bleeding and biliary fistula caused by pancreatic MOF is a factor in the death of the late SAP. The early stage of SAP to Shaoyang dialectical traditional Chinese medicine at Yang-Ming Yang-Ming, while the performance of serious chest in evidence for the node.Advanced TCM for drug hot flaming, hot node is internal organs. Chinese medicine dialectical recovery qi and yin found the two injured. The severe acute pancreatitis secondary infection occurred in the incidence of more than2to3weeks. Intestinal paralysis, TPN, the extent of pancreatic necrosis, early hypoxemia and abdominal surgery and intraperitoneal drainage were relation to the infection of the pancreas.Severe acute pancreatitis should be corrected to treat with early infection-related risk factors, especially to shorten the recovery time of intestinal funtion. Gram-negative bacteria is a severe acute pancreatitis the pancreas secondary bacterial infection, and of multi-drug resistant, therefore, clinical application of antibiotics must be reasonable. TongLiGongXia treatments can shorten the patients of severe acute pancreatitis first defecation time, days of hospitalization and reduced the operability, complication rate, and mortality. After discharge3months,SAP patients to take Chinese herb treatment can reduce AP recurrence and improve nutritional status in the long-term convalescence. |
