急性胰腺炎的诊疗.doc
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Evidence-based clinical practice guidelines for acute pancreatitis: proposals.
Mayumi T, Ura H, Arata S, Kitamura N, Kiriyama I, Shibuya K, Sekimoto M, Nago N, Hirota M, Yoshida M, Ito Y, Hirata K, Takada T; Working Group for the Practical Guidelines for Acute Pancreatitis. Japanese Society of Emergency Abdominal Medicine.
Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan.
BACKGROUND/PURPOSE: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the Japanese Society of Abdominal Emergency Medicine. METHODS: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed and levels of evidence were assessed. Practical recommendations were also graded. RESULTS: The present guidelines consist of introductions, a summary of recommendations, practice algorithms, definitions, epidemiology, diagnosis, severity assessment, and therapy. The main points of recommendation in these guidelines are: (1) measuring lipase for the diagnosis of acute pancreatitis (recommendation grade [RG], A). (2) The Severity of acute pancreatitis should be assessed using a scoring system, such as that of the Japanese Ministry of Health and Welfare or Acute Physiology and Chronic Health Evaluation (APACHE) II (RG, A). (3) Enhanced computed tomography (CT) should be used for assessment of degree of pancreatic necrosis and inflammation (RG, . (4) Prophylactic antibiotic administration should be used for severe pancreatitis (RG, A), but not for mild to moderate pancreatitis (RG, D). (5) Gabexate mesilate should be used for severe pancreatitis (RG, . Enteral feeding should be used for all pancreatitis (RG, . (7) Continuous hemodiafiltration and continuous arterial infusion of proteinase inhibitor and antibiotics may be of benefit (RG, C). Fine-needle aspiration should be done for the diagnosis of infectious pancreatic necrosis, and if positive, necrosectomy is indicated (RG, A). CONCLUSIONS: These guidelines provide useful information for physicians to manage this troublesome disease。
急性胰腺炎的循证医学临床实践指南2002
背景：近年关于急性胰腺炎的诊疗方法反复较多，因而很多方法存在地区差异性和时间差异性。有多个GUIDELINE发表，很多研究中心提出的干预措施也存在差距。为了给临床医生提供一个相对合理及易操作的诊疗策略，也同时更客观的向病人及家属提供疾病的信息。推出这个基于循证医学的《急性胰腺炎的循证医学临床实践指南2002》。由日本急腹症医学会组织，名古屋医科大学等12所大学的急诊、危重症、外科等医学中心共同完成的系统回顾。MEDLINE (1960-2000)共14821篇关于人类胰腺炎的文章及日本本国医学期刊1475篇共16296篇文献。系统回顾证据分级依据"the levels of evidence and grades of recommendations of the Oxford Centre for Evidence-Based Medicine"及"Guide to development of practice guidelines"。
关于急性胰腺炎的主要观点
说明：A+：有极好证据支持应用
B+：有中等度证据支持应用
C：有较少证据支持应用
A-：有极好证据支持不应用
B-：有极好证据支持不应用
关于急性胰腺炎的主要观点：A级
1对胰腺炎的诊断，血脂肪酶价值优于淀粉酶
2疑诊急性胰腺炎的病人必须拍胸片及腹部平片
3疑诊急性胰腺炎的病人入院时必须行腹部超声检查
4ERCP用于检查反复发作胰腺炎及疑诊胆石性胰腺炎
5严重度分级是急性胰腺炎管理所必须的。
6血清CRP(48小时内)对于急性胰腺炎严重度评估有效
7除非通过临床表现、实验室检查及超声确诊急性胰腺炎 ......
Evidence-based clinical practice guidelines for acute pancreatitis: proposals.
Mayumi T, Ura H, Arata S, Kitamura N, Kiriyama I, Shibuya K, Sekimoto M, Nago N, Hirota M, Yoshida M, Ito Y, Hirata K, Takada T; Working Group for the Practical Guidelines for Acute Pancreatitis. Japanese Society of Emergency Abdominal Medicine.
Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan.
BACKGROUND/PURPOSE: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the Japanese Society of Abdominal Emergency Medicine. METHODS: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed and levels of evidence were assessed. Practical recommendations were also graded. RESULTS: The present guidelines consist of introductions, a summary of recommendations, practice algorithms, definitions, epidemiology, diagnosis, severity assessment, and therapy. The main points of recommendation in these guidelines are: (1) measuring lipase for the diagnosis of acute pancreatitis (recommendation grade [RG], A). (2) The Severity of acute pancreatitis should be assessed using a scoring system, such as that of the Japanese Ministry of Health and Welfare or Acute Physiology and Chronic Health Evaluation (APACHE) II (RG, A). (3) Enhanced computed tomography (CT) should be used for assessment of degree of pancreatic necrosis and inflammation (RG, . (4) Prophylactic antibiotic administration should be used for severe pancreatitis (RG, A), but not for mild to moderate pancreatitis (RG, D). (5) Gabexate mesilate should be used for severe pancreatitis (RG, . Enteral feeding should be used for all pancreatitis (RG, . (7) Continuous hemodiafiltration and continuous arterial infusion of proteinase inhibitor and antibiotics may be of benefit (RG, C). Fine-needle aspiration should be done for the diagnosis of infectious pancreatic necrosis, and if positive, necrosectomy is indicated (RG, A). CONCLUSIONS: These guidelines provide useful information for physicians to manage this troublesome disease。
急性胰腺炎的循证医学临床实践指南2002
背景：近年关于急性胰腺炎的诊疗方法反复较多，因而很多方法存在地区差异性和时间差异性。有多个GUIDELINE发表，很多研究中心提出的干预措施也存在差距。为了给临床医生提供一个相对合理及易操作的诊疗策略，也同时更客观的向病人及家属提供疾病的信息。推出这个基于循证医学的《急性胰腺炎的循证医学临床实践指南2002》。由日本急腹症医学会组织，名古屋医科大学等12所大学的急诊、危重症、外科等医学中心共同完成的系统回顾。MEDLINE (1960-2000)共14821篇关于人类胰腺炎的文章及日本本国医学期刊1475篇共16296篇文献。系统回顾证据分级依据"the levels of evidence and grades of recommendations of the Oxford Centre for Evidence-Based Medicine"及"Guide to development of practice guidelines"。
关于急性胰腺炎的主要观点
说明：A+：有极好证据支持应用
B+：有中等度证据支持应用
C：有较少证据支持应用
A-：有极好证据支持不应用
B-：有极好证据支持不应用
关于急性胰腺炎的主要观点：A级
1对胰腺炎的诊断，血脂肪酶价值优于淀粉酶
2疑诊急性胰腺炎的病人必须拍胸片及腹部平片
3疑诊急性胰腺炎的病人入院时必须行腹部超声检查
4ERCP用于检查反复发作胰腺炎及疑诊胆石性胰腺炎
5严重度分级是急性胰腺炎管理所必须的。
6血清CRP(48小时内)对于急性胰腺炎严重度评估有效
7除非通过临床表现、实验室检查及超声确诊急性胰腺炎 ......
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