[Treatment of severe acute pancreatitis (30 cases). Respective role of surgery, intensive care and artificial nutrition (author's transl)].

Anesthesie, analgesie, reanimation Pub Date : 1981-01-01
C Vaysse, B Pradere, Y Parent, J P Boye, L Lareng, J L Gouzi
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Abstract

The authors report on a retrospective study of 30 severe acute pancreatitis. The severity of the illness is documented by operative statement and evolution of the disease = 50 p. cent of mortality. A first group of 10 patients (1972-1975) was treated by primary intensive care and rapid ablative surgery with 10 deaths. A second group of 20 patients (1976-1980) was treated by primary intensive care, artificial nutrition and secondary surgical drainage. Mortality is significantly lower in the second group (5 deaths). It is concluded that all severe acute pancreatitis should be initially managed by intensive metabolic care and respiratory support if necessary. The only indication for primary surgery is a diagnostic doubt with peritonitis or bowell infarction. The authors emphasize the improvement of the prognosis of severe acute pancreatitis related to hemodynamic and respiratory measures and to a better nutritionnal support. Surgery should be secondary on a well prepared patient. Drainage or sequestrectomy support a lower mortality than ablative surgery.

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重症急性胰腺炎治疗(30例)。手术、重症监护和人工营养各自的作用[作者简介]。
作者报告了30例严重急性胰腺炎的回顾性研究。疾病的严重程度可以通过手术记录和疾病的演变来证明= 50%的死亡率。第一组10例患者(1972-1975)接受初级重症监护和快速消融手术治疗,其中10例死亡。第二组20例患者(1976-1980)采用初级重症监护、人工营养和二次手术引流治疗。第二组的死亡率要低得多(5人死亡)。结论:所有重症急性胰腺炎应在初期进行强化代谢护理和必要时的呼吸支持。原发性手术的唯一适应症是对腹膜炎或肠梗塞的诊断有疑问。作者强调重症急性胰腺炎预后的改善与血液动力学和呼吸措施以及更好的营养支持有关。对于准备充分的病人,手术应该是次要的。引流或隔离切除术的死亡率低于消融手术。
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