| Objective:To explore the effect of CT guided puncture in the treatment of severe acute pancreatitis(SAP)with the concept of damage control and precision medicine.Methods:The collection of Dalian Central Hospital Affiliated to Dalian Medical University of hepatobiliary surgery during December 2010 ~2017 year in December admitted 100 cases of patients with severe acute pancreatitis clinical data,all patients were in December 2010 ~2017 year in December due to sudden abdominal pain and progressive admitted,are in line with Chinese medicine surgery branch of pancreatic surgery group of patients with severe acute pancreatitis diagnostic index.According to the enhanced CT or MRI results were included in this study,there will be 1 or more local complications of patients,divided into puncture treatment group and routine treatment group.The conventional treatment group 39 patients received continuous oxygen inhalation,fasting,fluid replacement,correction of acid-base balance and electrolyte disorder,acid suppression and the inhibition of pancreatic secretion and enzyme activity,improve microcirculation,nutrition therapy and other medical treatment.Puncture treatment group of 34 patients on the basis of conventional therapy group treated by CT guided percutaneous catheter drainage for treatment,the clinical effect of the treatment in the two groups were analyzed by statistical analysis,research and evaluation of curative effect of CT guided puncture for the treatment of severe acute pancreatitis and local complications.Results: Two groups of patients after different treatment plan,73 cases of 8 patients died,the total mortality rate(10.96%),puncture group 3 cases(4.11%),the conventional group 5 cases(6.85%).the puncture group treatment group blood calcium(2.3 + 0.5)mmol/L was significantly higher than the conventional group(2 + 0.1)mmol/L,the difference was significant(p<0.05).Puncture treatment group blood glucose(5.1 + 0.8)mmol/L,WBC(7.63 + 1.35)* 10*9/L,blood glucose was significantly lower than the conventional group(6.5 + 0.9)mmol/L,WBC(11.98 + 2.38)* 10*9/L and the difference was significant,with statistical significance(p<0.05)puncture group procalcitionin(PCT)(0.87 + 0.3)ng/ml was significantly lower than that of the conservative group(1.21 + 0.3)and ng/ml decreased significantly than that in the conservative group,the difference was significant(p<0.05).The APACHEII score of the puncture group(4.96 + 3.36)was significantly lower than that of the conventional group(9.14 + 3.12)(t=6.3241,P<0.05);the CTSI score of puncture group(1.2 + 0.4)was lower than that of the conventional group(2.3 + 0.3),and the difference was statistically significant(p<0.05).Puncture the blood urea nitrogen(BUN)and mmol/L(5.84 + 1.73)was significantly lower than the conventional group(6.81 + 2.34)mmol/L,decreased greatly,with statistical significance(p<0.05);serum creatinine(SCr)puncture group(274.36 + 34.43umol/L)decreased significantly,far lower than the normal group,with statistical significance(p<0.05)and puncture group the disappearing time of clinical symptoms(19.37 + 3.24),gastrointestinal function recovery time(4.56+ 2.34),total hospitalization time(24.35 + 6.41)were shorter than the conventional group,and the difference was significant,with statistical significance(p<0.05).It can be seen that the clinical effect of the puncture group is obviously better than that of the conventional group,and the difference is statistically significant(P<0.05).No significant postoperative bleeding and other adverse reactions were found in 46 cases of puncture therapy group after CT guided puncture,indicating that CT guided puncture for severe acute pancreatitis is a safe treatment plan.Conclusion:For patients with severe acute pancreatitis and local complications of patients,CT guided percutaneous catheter drainage in the treatment of the operationis relatively simple,well tolerated,and accurate positioning,small trauma,high safety,obvious curative effect,is a better way of clinical treatment,worth in clinical application. |
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