摘要：目的 探讨重症急性胰腺炎患者在CRRT治疗期间液体平衡管理的体验与需求，为优化临床液体管理及护理支持策略提供依据。方法 采用描述性质性研究方法，运用目的抽样法选取2024年5月—2025年12月在我院重症医学科接受CRRT治疗的13例重症急性胰腺炎患者进行半结构式深入访谈。采用Colaizzi七步分析法对访谈资料进行整理、编码、归类与主题提炼。结果 本研究最终提炼出4个主题、11个亚主题，分别为：①强烈而持续的身体不适体验（强烈的口渴感、身体肿胀与沉重、治疗期间寒冷与束缚）；②液体管理限制下的认知行为冲突（对限液医嘱情绪复杂、出入量监测引发的复杂感受、配合行为背后的动力与障碍）；③治疗过程中的负性情绪与心理调适（治疗初期的强烈恐惧与不确定感、无助感与自主权被削弱、在病痛中重建希望与韧性）；④对疾病信息与多维照护支持的迫切需求（信息缺乏引发困惑与焦虑、照护支持需求）。结论 重症急性胰腺炎患者在CRRT治疗期间，临床护理不仅应关注液体出入量等客观指标，还应重视患者的口渴等主观不适、限液过程中的认知行为冲突、治疗相关情绪反应及信息支持需求。

目的 探讨基于健康意识理论（HEC）的健康管理联合早期活动护理干预应用于急性胰腺炎（AP）患者的效果。方法 将南阳市第一人民医院2020年1月—2023年1月期间收治的80例AP患者作为研究对象,按照随机数字表法分为对照组（n=40）和观察组（n=40）。两组患者均按照AP护理常规进行护理,对照组予早期活动护理干预,观察组予早期活动护理和基于HEC的健康管理,观察两组健康行为能力、健康促进行为和并发症发生情况。结果 干预后,两组患者健康行为能力自评量表得分均高于干预前,且观察组得分高于对照组（P<0.05）;两组患者健康促进生活方式量表Ⅱ得分均高于干预前,且观察组得分高于对照组（P<0.05）;观察组并发症发生率（5.00%）低于对照组（20.00%）。结论 基于HEC的健康管理联合早期活动护理可以有效改善AP患者的健康行为能力、健康促进行为减少并发症的发生。

Objective To explore the effect of health management combined with early activity nursing intervention based on health as expanding consciousness（HEC）on patients with acute pancreatitis（AP）．Methods Eighty patients with AP admitted to the First People’s Hospital of Nanyang City from January 2020 to January 2023 were selected as the study subjects．They were randomly divided into a control group（n=40）and an observation group（n=40）using a random number table method．Both groups of patients received routine AP nursing care．The control group received early activity nursing intervention,while the observation group received early activity nursing and HEC based health management．The health behavior ability,health promotion behavior,and incidence of complications were observed in both groups．Results After the intervention,both groups of patients had higher scores on the Self Rating Health Behavioral Ability Scale than before the intervention,and the observation group had higher scores than the control group（P<0.05）．The scores of the Health Promotion Lifestyle Scale II for both groups of patients were higher than before intervention,and the scores of the observation group were higher than those of the control group（P<0.05）．The incidence of complications in the observation group（5.00%）was lower than that in the control group（20.00%）．Conclusions Health management based on HEC combined with early activity nursing can effectively improve the health behavior ability of AP patients,promote health behavior,and reduce the occurrence of complications．

目的 分析超早期阶梯式协同营养管理在改善重症急性胰腺炎患者喂养中的应用效果。方法 抽取2020年1月—2022年1月南阳市中心医院收治的80例重症急性胰腺炎患者为研究对象,随机数字表法分为观察组和参照组,各40例,两组患者均给予常规营养干预措施,其中观察组患者在以上基础上给予超早期阶梯式协同营养管理,对比两组患者的临床症状消退时间、营养状况、喂养相关并发症、喂养不耐受发生率。结果 与参照组相比,观察组患者的临床症状消退时间更短（P<0.05）,观察组患者的体质量指数、上臂肌围、肱三头肌皮褶厚度及血清清蛋白水平更高（P<0.05）;两组患者的喂养相关并发症主要包括恶心呕吐、误吸、腹泻、感染,观察组患者的喂养相关并发症发生率为7.50%,参照组患者的喂养相关并发症发生率为25.00%,观察组患者的喂养相关并发症发生率低于参照组（P<0.05）;观察组患者喂养不耐受发生2例（5.00%）,参照组患者喂养不耐受发生9例（22.50%）,观察组患者喂养不耐受发生率低于参照组（P<0.05）。结论 重症急性胰腺炎患者实施超早期阶梯式协同营养管理可降低喂养不耐受发生率及喂养相关并发症发生率,改善患者营养水平。

Objective To analyze the application effect of ultra early stepped collaborative nutrition management on improving feeding in patients with severe acute pancreatitis．Methods Eighty patients with severe acute pancreatitis admitted to our hospital from January 2020 to January 2022 were selected as research subjects and randomly divided into observation group and reference group,with 40 cases in each group．Patients in both groups were given conventional nutritional intervention measures,among which patients in the observation group were given super-early stepped collaborative nutritional management on the basis of the above．Clinical symptom resolution time,nutritional status,feeding related complications and feeding intolerance rate were compared between the two groups．Results Compared with the reference group,the time of clinical symptoms resolution in the observation group was shorter（P<0.05）,and the body mass index,upper arm muscle circumference,triceps skin fold thickness and serum albumin level in the observation group were higher（P<0.05）．The feeding-related complications of the two groups mainly included nausea and vomiting,aspiration,diarrhea and infection．The incidence of feeding-related complications in the observation group was 7.50%,and that in the reference group was 25.00%．The incidence of feeding-related complications in the observation group was lower（P<0.05）．There were 2 cases of feeding intolerance in the observation group,the feeding intolerance rate was 5.00%,and 9 cases of feeding intolerance in the reference group,the feeding intolerance rate was 22.50%,the feeding intolerance rate in the observation group was lower（P<0.05）．Conclusions Implementing ultra early stepped collaborative nutritional management in patients with severe acute pancreatitis can reduce the incidence of feeding intolerance and feeding related complications,and improve nutritional levels．

如何降低急性胰腺炎的病死率是一项意义重大的课题。日本2021版诊疗指南提出了对急性胰腺炎患者的“集束化管理措施”,在此指导下,日本急性胰腺炎总体病死率下降至2.6%,重症急性胰腺炎病死率下降至6.1%,远低于全球各国报道的病死率。本文对该指南之诊疗方案进行分析,并与我国现行指南进行对比,以期对AP患者的临床诊治提供指导意义,并期待日后有更多更深入的该领域相关研究。

It is a significant problem that how to reduce the mortality rate of acute pancreatitis．However,under the guidance of the Pancreatitis Bundles from the 2021 Edition of the Japanese Guidelines for Acute Pancreatitis of patients with acute pancreatitis,the overall fatality rate of acute pancreatitis in Japan has decreased to 2.6%,and the fatality rate of severe acute pancreatitis has decreased to 6.1%,which is much lower than the fatality rate reported around the world．We analyze the diagnosis and treatment methods of this guideline and compare it with the current guideline in China,in order to have more relevant studies in the future．

目的 探讨胃癌误诊为环状胰腺并胰腺炎并十二指肠梗阻的原因和治疗。方法 对本院收治的1例由胃癌误诊为环状胰腺并胰腺炎以及十二指肠梗阻患者的临床情况加以总结,并总结复习和分析相关文献。结果 本例患者虽最终明确诊断为胃癌,但病理提示分化差,合并全身多处骨转移,疾病进展迅速,后续放化疗效果欠佳。早期诊断、早期治疗是影响胃癌患者预后的关键。结论 胃癌骨转移的发病率低,极少进行骨转移评估,易造成误诊。当出现胃十二指肠流出道梗阻时,虽患者合并环状胰腺,仍需警惕胃癌的可能,及早完善全身检查,明确诊断,采取正确的治疗措施。

目的 探讨胰岛素联合乌司他丁在高脂血症性重症胰腺炎中的临床疗效。方法 研究资料来自广州市花都区人民医院肝胆胰外科自2018年—2020年收治的72例高脂血症性重症胰腺炎患者资料,所有患者按照不同治疗方案随机分为3组,每组各24例。对照组采用急性胰腺炎常规治疗(即生长抑素+液体疗法);乌司他丁组则于常规组上联用乌司他丁;而研究组在常规及联合乌司他丁治疗基础上加用胰岛素强化治疗,比较3组患者腹痛及胃肠功能恢复的时间、甘油三酯下降的水平,治疗前、治疗后第3天、7天的APACHE Ⅱ评分的变化情况。结果 研究组患者腹痛症状缓解及胃肠功能恢复时间均较对照组明显缩短、腹痛症状缓解时间较乌司他丁组缩短,且研究组甘油三酯下降水平较对照组和乌司他丁组快,而研究组第3天和第7天的APACHE-Ⅱ评分较常规组及乌司他丁组低,以上差别均有统计学意义(P<0.05)。结论 胰岛素联合乌司他丁可明显改善高脂血症合并重症急性胰腺炎腹部症状、缩短胃肠功能恢复时间、迅速降低血清甘油三酯水平,对患者近期疗效确切。

Objective To explore curative effect of insulin combined with ulinastatin in therapy of severe hyperlipidemic pancreatitis. Methods A total of 72 patients with hyperlipidemia complicated with severe acute pancreatitis were randomly divided into three groups according to different treatment plans, 24 cases in each group. The regular treatment of acute pancreatitis (somatostatin+liquid therapy) was carried out in control group. Base on the regular treatment of acute pancreatitis, ulinastatin was added in ulinastatin group. Base on the treatment of ulinastatin group, insulin was added in study group, and the time of abdominal pain and gastrointestinal function recovery, glycerin level and the APACHE Ⅱ score before and after treatment among three groups were compared. Results Compared with the control group and ulinastatin group, the time of abdominal pain relief and gastrointestinal function recovery in the study group were significantly shorter, the time of triglycerides level back to normal in the study group was shorter than the other two groups, while at the third and seventh day, the APACHE Ⅱ score of the study group was lower than that of other two groups, with statistical significance (P<0.05). Conclusions Insulin combined with ulinastatin could significantly improve abdominal symptoms of hyperlipidemia complicated with severe acute pancreatitis, promote the recovery of gastrointestinal function, and rapidly reduce the level of serum triglyceride.

目的 探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法 回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组, 每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例, 观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果 2组患者治疗后5~7 d内APACHE Ⅱ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72) vs (11.24±2.76) mmol/L]、血肌酐[(69.51±15.03) vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693, 5.924, 7.440, 9.362, 5.235, 6.801, 5.018,P均＜0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs (5.22±1.51) d]、体征指标稳定时间[(2.52±1.38) vs (4.39±1.50) d]、胃肠功能恢复时间[(4.48±1.27) vs (6.21±1.55) d]以及ICU住院时间[(15.03±2.21) vs (18.44±3.27) d]均低于对照组,结果分析差异有统计学意义(t=5.954, 5.190, 4.884,4.888,P均＜0.05)。结论 与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out. The patients were divided into the observation group and the control group according to different treatment regimens, with 32 cases in each group, and the baseline levels of the two groups were consistent. Patients in the control group were treated with conventional medical treatment, and the patients in the observation group were treated with CRRT on the basis of the control group, and the efficacy of the two groups were analyzed and compared. Results The APACHE II scores [(11.02±3.14) vs (13.98±3.27)]、triglyceride[(4.02±1.05) vs (5.62±1.11) mmol/L], C-reactive protein[(88.25±6.73) vs (104.41±10.28) ng/L], procalcitonin[(13.12±4.33) vs (18.55±3.96) ng/mL], blood urea nitrogen[(7.33±1.72) vs (11.24±2.76) mmol/L], serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L] of patients in both groups were significantly decreased within 5-7 days after treatment compared with those before treatment, and the decrease of the above indicators in the observation group was significantly greater than that in the control group, P<0.05. The remission time of symptoms[(3.15±1.26) vs (5.22±1.51) d], the stabilization time of signs[(2.52±1.38) vs (4.39±1.50) d], the recovery time of gastrointestinal function[(4.48±1.27) vs (6.21±1.55) d] and the length of ICU stay[(15.03±2.21) vs (18.44±3.27) d] in the observation group were lower than those in the control group, and the analysis of the results was statistically significant (t=5.954, 5.190, 4.884,4.888,all P＜0.05). Conclusions Compared with conventional medical treatment, additional CRRT treatment can significantly improve the inflammatory indicators of SAP, help patients survive from critical state of SAP, which has positive clinical value.

目的 探讨miR-148a对大鼠急性胰腺炎细胞模型中细胞自噬的影响。方法 选取培养AR42J细胞,细胞分为4组,即正常对照组、模型组、miR-148a mimics组及miR-148a阴性对照组。利用Lipofectamine 2000转染miR-148a mimics及阴性对照miR-148a至AR42J细胞,继续培养48 h后,利用浓度为200 μmol的牛磺胆酸钠盐(TLCs)刺激以上两组及模型组AR42J细胞20 min,正常对照组不做处理,然后提取各组细胞蛋白及RNA。利用RT-qPCR检测各组细胞中miR-148a的表达;利用CCK8实验检测各组细胞的活性;利用ELISA法检测各组细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量;利用Western blot检测自噬相关的基因Beclin1、LC3Ⅰ、 LC3Ⅱ的表达。结果 RT-qPCR结果显示,与正常对照组相比较,模型组心肌细胞中miR-148a mRNA的表达降低,而miR-148a mimics组细胞中miR-148a mRNA的表达显著升高;CCK-8实验结果显示,转染miR-148a mimics至细胞后,可提高模型细胞的活性;ELISA实验结果显示,与模型组相比较,转染miR-148a mimics至细胞后,细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量显著降低;Western blot结果显示,与模型组相比较,转染miR-148a mimics至细胞后,可降低细胞中Beclin1的表达,降低LC3Ⅱ/LC3Ⅰ的比率。结论 利用miR-148a mimics提高TLCs刺激的细胞模型中的miR-148a表达后,细胞中Beclin1的表达降低,LC3Ⅱ/LC3Ⅰ的比率降低,抑制了细胞自噬,降低了炎性因子IL-6、IL-1β、TNF-α的释放,从而提高了细胞的活性,miR-148a可通过调节模型细胞的自噬而发挥细胞保护作用。

Objective To investigate the effect of miR-148a on autophagy in rat acute pancreatitis cell model. Methods AR42J cells were cultured and divided into 4 groups: normal control group, model group, miR-148a mimics group and miR-148a negative control group. miR-148a mimics and miR-148a negative control were transfected to AR42J cells with Lipofectamine 2 000, then cells were cultured for 48 h. The AR42J cells were stimulated with sodium taurocholate (TLCs) at a concentration of 200 μmol for 20 min, the normal control group was not treated, then the protein and RNA were extracted in each group. The expression of miR-148a was detected by RT-qPCR in each group. The activity of cells was detected by CCK8 assay in each group. The contents of IL-6, IL-1β and TNF-α in the cell culture medium were detected by ELISA. Western blot was used to detect the expression of autophagy related genes Beclin1, LC3Ⅰ and LC3Ⅱ. Results RT-qPCR results showed that the expression of miR-148a mRNA in model group was significantly lower than that in normal control group, while the expression of miR-148a mRNA in miR-148a mimics group was significantly higher than that in normal control group. The results of CCK-8 assay showed that miR-148a could significantly increase the activity of model cells stimulated by TLCs. The results of ELISA showed that the contents of IL-6, IL-1β and TNF-α in cell culture medium were significantly decreased after miR-148a mimics transfection, compared with the model group. Western blot showed that miR-148a mimics could significantly decrease the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ, compared with the model group. Conclusion miR-148a mimics was used to enhance the expression of miR-148a in cells model stimulated by TLCs, the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ were decreased, and the autophagy was inhibited. The release of IL-6, IL-1β and TNF-α was decreased and the activity of cells was increased. miR-148a plays a cellular protective role by regulating autophagy in model cells.

目的 分析急性胰腺炎患者给予罗格列酮联合乌司他丁治疗的疗效。方法 采用分层随机法将我院于2019年1月—2020年12月收治的94例急性胰腺炎患者分为对照组和观察组,对照组(n=47)单纯给予乌司他丁治疗,观察组(n=47)给予罗格列酮联合乌司他丁治疗,对比两组患者疗效、病情恢复时间、炎症因子、肝功能指标。结果 两组患者治疗前C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-17(interleukin-17,IL-17)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)水平差异无统计学意义(P＞0.05),治疗后观察组治疗总有效率较对照组高,且首次排气时间、腹胀消失时间、肠鸣音消失时间、淀粉酶恢复时间更短,CRP、IL-6、IL-17、ALT、AST水平更低,数据差异有统计学意义(P＜0.05)。结论 急性胰腺炎患者给予罗格列酮联合乌司他丁治疗可改善症状,促进康复,减轻炎性损伤,保护肝功能,是兼具疗效与安全性的治疗方法。

目的 观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法 回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果 经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.