【摘要】 目的 利用首過時間技術進行全胰腺CT灌注掃描，了解正常胰腺CT灌注的特點。 方法 2006年6月-2007年3月， 64例正常胰腺患者行64排螺旋CT灌注掃描，測量胰頭、胰體及胰尾的灌注值、強化峰值、達峰時間和血容量。分別按患者的性別、年齡及胰腺測量的部位分組，將灌注參數進行統計分析。 結果 ①男性胰腺的血容量高于女性（Plt;0.05），其余灌注參數在兩性間差異無統計學意義（Pgt;0.05）。②41~60歲組的灌注值低于lt;40歲組和gt;60歲組；gt;60歲組的強化峰值高于41~60歲組；41~60歲組的達峰時間長于lt;40歲組；gt;60歲組的血容量高于41~60歲組（Plt;0.05）。③胰體和胰尾的灌注值高于胰頭（Plt;0.05），其余灌注參數在胰腺不同部位差異無統計學意義。 結論 正常胰腺血流狀況在不同性別、不同年齡段及不同部位存在差異，首過時間技術應用于正常胰腺能反映這些特征。【Abstract】 Objective To investigate the CT perfusion features of normal pancreas with first-pass technique with 64-MDCT. Methods Perfusion CT was performed on 64 patients with normal pancreas from June 2006 to March 2007. Four perfusion parameters, including perfusion, peak enhancement, time to peak, and blood volume, were obtained at the head, body and tail of the pancreas. Perfusion parameters were compared between different sexes, among different age groups and among different sites. Results ① Blood volume of male was significantly higher than that of female (Plt;0.05). ② The perfusion value in the age group of 41-60 was significantly lower than that in the age group of lt;40 and gt;60 (Plt;0.05). The peak enhancement in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). The time to peak in the age group of 41-60 was significantly longer than that in the age group of lt;40 (Plt;0.05). The blood volume in the age group of gt;60 was significantly higher than that in the age group of 41-60 (Plt;0.05). ③The perfusion values of the body and the tail were significantly higher than that of the head (Plt;0.05). Conclusion There are significant differences in the perfusion parameters between different sexes and among several age groups and sites. The first-pass technique of perfusion applied in normal pancreas can reflect these features.
【摘要】 目的 探討比較全腸內營養支持和全腸外營養支持對急性重癥胰腺炎（severe acute pamcreattis，SAP）預后的影響。 方法 將2003年1月-2008年12月收治的54例SAP患者于入院后第1周內隨機分為兩組:全腸內營養（A）組27例；全腸外營養（B）組27例。兩組患者均靜脈給予廣譜抗生素預防感染。入院時CT掃描及C反應蛋白水平顯示兩組患者具有可比性。 結果 B組22例患者發生器官衰竭，明顯高于A組（5例）。B組22例患者接受了手術治療，A組手術患者6例（Plt;0.05）。A組患者胰腺壞死后感染發生率明顯低于B組（Plt;0.05）。B組患者死亡率高于A組（Plt;0.05）。 結論 全腸內營養支持，不僅可以促進腸道功能的恢復和營養狀況的維持，還可減少腸源性感染的發生率，對減少SAP的感染性并發癥和病死率具有積極作用。【Abstract】 Objective To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP). Methods A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups. Results Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05). Conclusion Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.
摘要:目的：探討急性重癥胰腺炎（SAP）早期不同種類液體復蘇對其預后的影響。方法：應用隨機對照的方法,分別對2007年12月~2009年10月同期入院的48例SAP患者,隨機分成兩組,試驗組和對照組。試驗組第一周內液體復蘇采用晶體液和人工膠體（羥乙基淀粉）,對照組采用晶體液,其他治療方法不變。然后統計其第一周死亡率、ARDS、多器官功能障礙綜合征（MODS）發生率,對比兩組患者呼吸頻率、血氧飽和度和紅細胞壓積（HCT）差異,以及兩組患者腸功能恢復時間、住院時間以及并發癥發生率。結果：試驗組的液體復蘇較對照組顯著改善SAP的各項指標（P＜005）。血清乳酸水平（15±05）mmol/L,紅細胞壓積(HCT)為（324±69）%,ScvO2為（817±152）%,病死率83%,MODS發生率333%,〖HT5”H〗結論:〖HT5”SS〗 SAP早期聯合應用晶膠體進行液體復蘇可有效恢復循環血容量和防止體液潴留,顯著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.
