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目的:探讨高海拔地区重症急性胰腺炎(SAP)治疗方法。方法:对1995年—2006年收治的94例长期居住在海拔2 260m~4 000m的青海省内SAP患者的治疗方法、手术指征、手术方式进行分析。结果:非手术治疗49例,I级36例,Ⅱ级13例,I级治愈32例,Ⅱ级治愈8例,非手术治愈40例,治愈率81.6%;手术治疗45例,Ⅰ级17例,Ⅱ级28例,I级治愈12例,Ⅱ级治愈15例,手术治愈27例,治愈率60%。结论:发生在高海拔地区的SAP经过积极的非手术治疗,大部分可以治愈,但也不能忽视手术治疗在SAP中的地位,要以个体化治疗为主。改善和纠正低氧血症,降低红细胞压积及血液粘度,疏通全身和胰腺微循环是高海拔地区非手术治疗SAP的关键措施。手术治疗要借鉴“损伤控制性外科模式”的救治理念,力求简单,安全有效。
Objective: To explore the treatment of severe acute pancreatitis (SAP) in high altitude area. Methods: 94 cases of long-term residency in Qinghai Province from 2 260m to 4 000m admitted from 1995 to 2006 were analyzed retrospectively. Results: Non-surgical treatment of 49 cases, 36 cases of grade I, 13 cases of grade Ⅱ, 32 cases of grade I, 8 cases of grade Ⅱ cure, 40 cases of non-surgical cure, the cure rate was 81.6%; 45 cases of surgical treatment, Ⅰ grade 17 cases , 28 cases of grade Ⅱ, 12 cases of grade I, 15 cases of grade Ⅱ, 27 cases were cured, the cure rate was 60%. CONCLUSIONS: SAP, which occurs in high altitude areas, can be cured mostly through active non-surgical treatment. However, surgical treatment should not be ignored in SAP. Individualized treatment should be the mainstay. To improve and correct hypoxemia, reduce hematocrit and blood viscosity, and to clear the systemic and pancreatic microcirculation is the key measure for non-surgical treatment of SAP at high altitude. Surgical treatment should learn from the “control model of injury control” concept of treatment, and strive to be simple, safe and effective.