急性胰腺炎Chapter 12 Acute pancreatitis
学习目标
1.急性胰腺炎定义、症状和诊断
2.急性胰腺炎的治疗原则
3.掌握以下词汇
abdominal bloating 腹胀
waist and back pain 腰背部疼痛
significant 显著的
mirabilite 芒硝
rhubarb 大黄
Zhang Jun is an ICU patient diagnosed with acute pancreatitis.He had epigastric pain, abdominal bloating, together with waist and back pain for one day after drinking at a dinner.Xiao Ran is his primary nurse.She is talking with Zhang Jun.
Xiao Ran: Hi, Zhang Jun, how are you feeling now? Is your abdominal pain getting better?
Zhang Jun: No, I feel awful, with terrible pain in my abdomen.What's wrong with me?
Xiao Ran: I have to tell you that you have acute pancreatitis.It is an inflammation ofthe pancreas and surrounding tissues.It is caused by the activation of pancreatic enzymes in the pancreas.Clinical manifestations include acute epigastric pain, nausea, vomiting, fever,and significantly increased amylase in blood and urine.
Zhang Jun: Oh, how can I relieve the abdominal distention and pain?
Xiao Ran: Clinical data has confirmed that rhubarb enema combined with mirabilite external application can effectively alleviate abdominal distension and pain.Rhubarb increases the secretion of bile.As a laxative, it promotes intestinal peristalsis, eliminates intestinal inflammatory factors and protects gastrointestinal mucosal barrier.Mirabilite external application can absorb peritoneal exudates, relieve inflammation and pain, prevent infection, improve local microcirculation, and promote the recovery ofgastrointestinal function.
Zhang Jun: Thank you.How is acute pancreatitis treated?
Xiao Ran: Treatments for acute pancreatitis include dry fasting, effective fluid resuscitation, maintenance of water and electrolyte balance, nutritional support, anti-infection treatment,and prevention of local and systemic complications.The most effective treatment is early and effective fluid resuscitation.Early inflammation can cause blood capillary leakage, leading to insufficient blood circulation.Effective liquid resuscitation helps to maintain blood volume, ensure the pancreas microcirculation perfusion, and further prevent local and systemic complications,such as pancreatic necrosis, systemic inflammatory response syndrome and multiple organ failures.
Zhang Jun: This sounds serious and I am quite worried.
Xiao Ran: Take it easy.Acute pancreatitis itself is not scary.What's terrible is the late complications.If you follow the treatment plan, you will get well soon.
Zhang Jun: Ok, I will do what you said.
Xiao Ran: Come on! Let's work together to conquer the disease.
译文
住在ICU的张军是一位急性胰腺炎患者，聚餐饮酒后上腹痛、腹胀伴腰背部疼痛1天，被诊断为急性胰腺炎，小冉是他的责任护士，正在和张军交流。
小冉：嗨，张军，现在感觉怎么样，腹痛症状有缓解吗？
张军：没有，我感觉糟糕透了，腹部胀痛得厉害，我得了什么病？
小冉：我很抱歉地告诉你，你得了急性胰腺炎。急性胰腺炎是多种病因导致胰酶在胰腺内被激活后，引起胰腺及其周围组织自身消化、水肿、出血甚至坏死的炎症反应。临床以急性上腹痛、恶心、呕吐、发热和血 / 尿淀粉酶明显升高等为特点。
张军：哦，怎样才能缓解腹部胀痛呢？
小冉：临床数据证实，中药大黄灌肠联合芒硝外敷能有效缓解腹部胀痛，大黄具有利胆、泻下、促进肠道蠕动、清除肠道内炎症因子、保护胃肠道黏膜屏障；芒硝外敷具有吸收腹腔渗液、消炎镇痛、预防感染、改善局部微循环、促进与恢复消化道功能等功效。
张军：谢谢，急性胰腺炎应该怎么治疗呢？
小冉：急性胰腺炎的治疗措施包括禁食、禁水、有效的液体复苏、维持水电解质平衡、营养支持、抗感染治疗、防治局部及全身并发症。最有效的治疗是早期有效的液体复苏，炎症反应会引起毛细血管渗漏，导致循环血量不足，有效的液体复苏能维持血容量，保证了胰腺的微循环灌注，进一步防止局部和全身并发症的发生，如胰腺坏死、全身炎症反应综合征以及多器官功能衰竭。
张军：听起来很严重，我很担心。
小冉：不用担心，急性胰腺炎本身不可怕，可怕的是后期并发症，如果好好配合治疗，相信你很快就能好起来的。
张军：好的，我一定按照你说的做。
小冉：加油！我们一起努力战胜疾病。