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Intensivtherapie bei schwerer Pankreatitis

  • E. Martin
  • H. Schmidt
Conference paper
  • 18 Downloads
Part of the Refresher Course — Aktuelles Wissen für Anästhesisten book series (REFRESHER COUR, volume 19)

Zusammenfassung

Die akute Pankreatitis stellt ein Krankheitsbild mit einem breiten Spektrum klinischer Erscheinungsformen dar. Schätzungsweise 80% der akuten Episoden zeigen einen milden, selbstlimitierenden Verlauf. Das pathomorphologische Bild ist hierbei durch ein interstitielles Ödem des Pankreas mit minimalen Fettgewebsnekrosen gekennzeichnet. Diese Patienten zeigen unter einer supportiven Basistherapie ohne spezifische Behandlungsverfahren eine raschen Rückgang der klinischen Symptomatik [1]. Die bei 5–20% aller Pankreatitiden auftretende schwere, nekrotisierende Verlaufsform ist aufgrund der assoziierten renalen, pulmonalen und hämodynamischen Komplikationen durch eine hohe Letalität gekennzeichnet [2]. Morbidität und Letalität der nekrotisierenden Pankreatitis werden von der Wirkung vasoaktiver und toxischer Substanzen, der Ausdehnung von Fettgewebs- und Parenchymnekrosen sowie einer sekundären bakteriellen Kolonisation des nekrotischen Materials bestimmt [3].

Literatur

  1. 1.
    Reynaert MS, Dugernier T, Kestens PJ (1990) Current therapeutic strategies in severe acute pancreatitis. Intensive Care Med 16: 352–362PubMedCrossRefGoogle Scholar
  2. 2.
    Ranson JHC (1984) Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol 14: 843–863Google Scholar
  3. 3.
    Beger HG, Bittner R, Block S, Büchler M (1988) Bacterial contamination of pancreatic necrosis. A prospektive clinical study. Gastroenterology 91: 433Google Scholar
  4. 4.
    Ranson JHV (1981) Conservative surgical treatment of acute pancreatitis. World J Surg 5: 351–359PubMedCrossRefGoogle Scholar
  5. 5.
    Smadja C, Bismuth H (1986) Pancreatic debridement in acute necrotizing pancreatitis: an obsolete procedure? Br J Surg 73: 408–412PubMedCrossRefGoogle Scholar
  6. 6.
    Beger HG, Krautzberger W, Bittner R, Block S, Büchler M (1985) Results of surgical treatment of necrotizing pancreatitis. World J Surg 9: 972–979PubMedCrossRefGoogle Scholar
  7. 7.
    Rattner DW, Warshaw AL (1988) Surgical intervention in acute pancreatitis. Crit Care Med 16: 89–95PubMedCrossRefGoogle Scholar
  8. 8.
    Singer MV, Gyr K, Sarles H (1985) Revised classification of pancreatitis. Gastroenterology 89: 683–685PubMedGoogle Scholar
  9. 9.
    Schmitz-Moormann P (1987) Akute Pankreatitis, Morphologie und Pathogenese. Verh Dtsch Ges Path 71: 161–174Google Scholar
  10. 10.
    Klar E (1992) Ätiologie und Pathogenese der akuten Pankreatitis. Helv Chir Acta 59: 7–16PubMedGoogle Scholar
  11. 11.
    Allan J, White TT (1974) An alternate mechanism for the formation of protein plugs in chronic calcifying pancreatitis. Digestion 11: 428–431PubMedCrossRefGoogle Scholar
  12. 12.
    Brugge WR, Burke CA, Brand DL, Chey WY (1985) Increased interdigestive pancreatic trypsin secretion in alkoholic pancreatic disease. Dig Dis Sci 30: 431–439PubMedCrossRefGoogle Scholar
  13. 13.
    Blank S, Wise L, Gersten A (1983) Risk factors in acute pancreatitis. Am J Gastroenterol 78: 637–642Google Scholar
  14. 14.
    Garca-Szabo RR, Malik AB (1984) Pancreatitis-induced increase in lung vascular permeability. Am Rev Respir Dis 129: 580–583Google Scholar
  15. 15.
    Di Carlo V, Nespoli A, Chiesa R (1981) Hemodynamic and metabolic impairment in acute pancreatitis. World J Surg 5: 329–339PubMedCrossRefGoogle Scholar
  16. 16.
    Beger HG, Bittner R, Büchler M (1986) Hemodynamic data patterns in patients with acute pancreatitis. Gastroenterology 90: 74–78PubMedGoogle Scholar
  17. 17.
    Schafmeyer A, Köhler H, Martell J (1989) Hämodynamische Charakteristika der nekrotisierenden Pankreatitis. Zentrbl Chir 114: 107–113Google Scholar
  18. 18.
    Bittner R, Block S, Büchler M, Beger HG (1987) Pancreatic abscess and infected pancreatic necrosis - different local septic complications in acute pancreatitis. Dig Dis Sci 32: 1082PubMedCrossRefGoogle Scholar
  19. 19.
    Malfertheimer P, Büchler M, Schoetensack C (1987) Laboratory parameters for the detection of acute necrotizing pancreatitis. Digestion 38: 38–42Google Scholar
  20. 20.
    Gudgeon AM, Heath DI, Hurley P, Jehanli A, Patel G (1990) Trypsinogen activation peptides assay in the early prediction of severity of acute pancreatitis. Lancet I: 4–8CrossRefGoogle Scholar
  21. 21.
    Ranson JHC, Rifkind KM, Roses DF (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139: 69–84PubMedGoogle Scholar
  22. 22.
    Silverstein W, Isikoff MB, Hill MC, Barkin J (1981) Diagnostic imaging of acute pancreatitis: prospective study using CT and sonography. AJR 137497–501Google Scholar
  23. 23.
    Clavien PA, Hauser H, Meyer P (1988) Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. Am J Surg 155: 457–466PubMedCrossRefGoogle Scholar
  24. 24.
    Ranson JHC (1979) The timing of biliary surgery in acute pancreatitis. Ann Surg 189: 654–663PubMedCrossRefGoogle Scholar
  25. 25.
    Blamey SL, Imrie CW (1984) Prognostic factors in acute pancreatitis. Gut 25: 1340–1346PubMedCrossRefGoogle Scholar
  26. 26.
    Creutzfeld W, Lankisch PG (1981) Intensive medical treatment of severe acute pancreatitis. World J Surg 5: 341–350CrossRefGoogle Scholar
  27. 27.
    Staritz M, Poralla T, Manns M, Meyer zum Büschenfelde KH (1986) Effect of modern analgesic drugs ( Tramadol, pentazocine, and buprenorphin) on the bile duct sphincter in man. Gut 27: 265–287CrossRefGoogle Scholar
  28. 28.
    Lankisch PG (1987) Möglichkeiten and Grenzen der konservativen Behandlung der akuten Pankreatitis. Chirurg 58: 64–69PubMedGoogle Scholar
  29. 29.
    Niesel HC, Klimpel L, Kaiser H, Bernhardt A, AlRafai S, Lang U (1991) Epidurale Blockade zur Analgesie and Behandlung der akuten Pankreatitis. Reg Anaesth 14: 97–100PubMedGoogle Scholar
  30. 30.
    Sitzman J, Steinborn PA, Zinner MH (1989) TPN and alternative energy substrates in the treatment of severe acute pancreatitis. Surg Gynecol Obstet 168: 311–317Google Scholar
  31. 31.
    Pfisters PWT, Ranson JHC (1992) Nutritional support of acute pancreatitis. Surg Gynecol Obstet 175: 275–284Google Scholar
  32. 32.
    Edelman K, Valenzuela JE (1983) Effect of intravenous lipid on human pancreatic secretion. Gastroenterology 85: 1063–1066PubMedGoogle Scholar
  33. 33.
    Trapnell JE, Rigby CC, Talbot CH, Duncan EHL (1974) A controlled trial of trasylol in the treatment of acute pancreatitis. Br J Surg 61: 177–182PubMedCrossRefGoogle Scholar
  34. 34.
    MRC Multicentre Trial of Glukagon and Aprotinin (1977) Death from acute pancreatitis. Lancet 632–635Google Scholar
  35. 35.
    Büchler M, Malfertheimer P, Uhl W, Stockmann F, Schölmerich J (1990) The german multicentre doubleblind randomised study of gabexate-mesilat (4 g/day IV) in acute pankreatitis. Abstract Gastroenterology 98: A214Google Scholar
  36. 36.
    Leese T, Holliday M, Watkins M, Neoptolemos JP, Thomas WM (1988) Preliminary results of of a multicentre controlled clinical trial of high-volume fresh frozen plasma therapy in prognostically severe acute pancreatitis. Digestion 40: 97–100CrossRefGoogle Scholar
  37. 37.
    Lankisch PG, Otto J, Göke B, Rahlf G (1986) No effect of ranitidine on acute experimental pancreatitis. Dig Dis Sci 31: 780–783PubMedCrossRefGoogle Scholar
  38. 38.
    Cameron JL, Mehigan. D, Zuidema GD (1979) Evaluation of atropine in acute pancreatitis. Surg Gynecol Obstet 148: 206–208Google Scholar
  39. 39.
    Goebell H, Ammann R, Herfarth C, Horn J, Hotz J (1979) A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis. Scand J Gastroenterol 14: 881–889PubMedCrossRefGoogle Scholar
  40. 40.
    Usadel KH, Überla KK, Leuschner U (1985) Treatment of acute pancreatitis with somatostatin: results of the multicenter double-blind trial (APIS-study). Dig Dis Sci 30: 992–997Google Scholar
  41. 41.
    Klar E, Herfarth C, Messmer K (1990) Therapeutic effect of isovolemic hemodilution with dextran 60 on the impairment of pancreatic microcirculation in acute biliary pancreatitis. Ann Surg 211: 346–353PubMedCrossRefGoogle Scholar
  42. 42.
    Schmidt J, del Castillo Fernandez, Rattner DW, Lewandrowsky KB, Messmer K, Warshaw AL (1993) Hyperoncotic ultrahigh molecular weight dextran solutions reduce trypsinogen activation, prevent acinar necrosis, and lower mortality in rodent pancreatitis. Am J Surg 165: 40–45PubMedCrossRefGoogle Scholar
  43. 43.
    Barzilay E, Kessler D, Berlot G, Gullo A, Geber D, Ben-Zeev I (1989) Use of extracorporal supportive techniques as additional treatment for septic-induced multiple organ failure patients. Crit Care Med 17: 634–637PubMedCrossRefGoogle Scholar
  44. 44.
    Tonnesen E, Hansen M, Höhndorf K, Bendtzen K, Diamant M (1991) Cytokines in plasma and ultrafiltrate in relation to hemofiltration (abstract). Anesthesiology 75: A266CrossRefGoogle Scholar
  45. 45.
    Bellomo R, Tipping P, Boyce N (1993) Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients. Crit Care Med 21:522–526PubMedCrossRefGoogle Scholar
  46. 46.
    Blinzler L, Hausser J, Bödeker H, Zaune U, Martin E, Gebhardt C (1991) Conservative treatment of severe necrotizing pancreatitis using early continuous venovenous hemofiltration. Contrib Nephrol 93: 234–236PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • E. Martin
  • H. Schmidt

There are no affiliations available

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