The Clinical Significance Of The Early Peritoneal Lavage In Severe Acute Pancreatitis

Savere acute pancreatitis，which is one of emergencies of alimentary system，is akind of chemical inflammatory disease.It is initiated from the self-digestion of pancreasand surrounding tissue caused by activated pankrin.The incidence rate by year is5-80/100，000with the gradually increasing tendency in the world. In the past severaldecades the mortality of AP remain9-20%， and the mortality of severe acutepancreatitis reach up to30%.As far as a kind of common acute abdomen with severe pathological lesion andprompt progress，the lack of rapid and effective diagnosis methods on early stage stillexists. There are some reports said the rate of definite diagnosis is only20-30%in thedead with AP by autopsy.To judge the severity of AP，in1974a scoring system was contrived by a foreignscholar named Ranson and whereafter was improvsd to be the clinicall common“Ranson Standard” to estimate the prognosis of AP. Now the scoring system hasevolved a system composed of a series of indices. At present，the acute physiology andchronic health evaluation Ⅱsystem (abbreviated as APACHE Ⅱ)，the computedtomography severity index (abbreviated as CTSI)are widely used in clinic.Modrau et al. consider that APACHEⅡ is the optimality criterion of prognosisestimation of SAP patients. However, an increasing number of researchers believe thatdynamic APACHE Ⅱis needed to increase the accuracy rate of diagnose. According toresearch[10], conducting APACHE Ⅱin succession, observing the dynamic tendency ofthe score has important implications to judge the clinical situation and guide the treatment.Tissue damage which is caused by severe acute pancreatitis stimulatethe inflammatory cells to release inflammatory medium，itinitiate systemicinflammatory response syndrome.,to multiple organ dysfunction syndrome，and to dead. When the C Reaction Protein is in normal circumstances, there is onlytrace amount of CRP (＜10mg/L) in blood serum. When you are suffered tissue injuryor inflammation, the level of CRP will increase continuously to inform the acuteinflammation and tissue necrosis. The level and variation tendency of the CRP duringthe reaction period of acute pancreatitis can estimate the severity and recovery of illness.ACHE Ⅱsystem can calculate the severity and prognosis of SAP early, which has theguiding significance for clinic treatment. APACHE Ⅱnow has been widely applied tothe illness evaluation of acute pancreatitis. If the APACHE Ⅱscore is higher, it meansthat the illness is more sever. Observing the variation tendency of APACHE Ⅱhasimportant implications for the judge of SAP and the guidance of clinic treatment.Neutrophile granulocyte (NEU) is an important part of body immunity and defensivesystem. It plays an important role in the formation, development and recovery ofinflammation. Normally, NEU lives in an apoptosis way, and be identified andswallowed by macrophage. O,NeillS et al. noted that the recession of the SAPinflammatory reaction rely on the apoptosis of neutrophile granulocyte and the delay ofrecession is related to the persistence of inflammation reaction and the secondary issueinjury. The mechanism of MODS brought by SAP is complex. SAP ascites contains alarge number of toxic substances and inflammatory medium which can lead to SIRS.According to a lot of researches and clinical materials, there is a common path betweenthe development of acute inflammation and the formation of MODS, i.e. SIRS. ObjectiveThe level of the CRP, APACHEⅡ score and NUE were.The time of SIRS and the rates of MODS were also compared of severe acute pancreatitis. To explore the clinical significance of the early peritoneal lavage in severe acute pancreatitis(SAP).Method:Choose50patients hospitalized in our hospital from sep.2010to Dec.2011, anddivide them into two groups randomly, the early laparoscopic peritoneal lavage group(25patients) and conventional treatment group (25patients). Prohibit water drinking inboth groups at the same time and provide them with conventional treatments, such asgastrointestinal decompression, infection prevention, fluid infusion and acid productionand enzyme inhibition, while the patients in the former group have been additionallyapplied early laparoscopic peritoneal lavage treatment. Compare the C-reactive protein(CRP), APACHE Ⅱ score andlevel of neutrophils of the patients in two groups beforethe treatment,3days and7days after the treatment, and compare the duration ofsystemic inflammatory response syndrome (SIRS), the number of organs with multipleorgan dysfunction syndromes (MODS) and fatality rate in two groups. T test is appliedin the comparison in both groups. When P is less than0.05, the result has statisticalsignificanceResultsThere were no significance in the level of CRP, APACHEⅡ score and NUE before treatment between two groups(P＞0.05). There were differences in the level of CRP, APACHEⅡ score, NEU3days after treatment (P＜0.05) and significance differences7days after treatment (P＜0.01). The time of SIRS，the rates of death and the rates of MODS were significantly different between two groups(P＜0.05). Conclusion:Conclusion: early laparoscopic peritoneal lavage is significant in clinic treatmentto reduce the early acute inflammatory reaction of SAP, cut off the SIRS development,and decrease the morbidity rate and fatality rate. It is easy to apply and efficient withobvious effect in SAP treatment. It is an effect treatment to apply early laparoscopicperitoneal lavage based on conventional treatment, worthy clinical use.