急性胰腺炎治疗教学课件.ppt

Corticosteroids 皮质类固醇 Again controversial in cats 猫同样有争议 Deleterious effects are possible 病情因此可能会恶化 Used more commonly than dogs 较犬常用 Treatment 治疗 Infiltrates of lymphocytes淋巴细胞浸润 Acute Pancreatitis急性胰腺炎 Prognosis 预后 Guarded 不佳 Often get repeated bouts 通常会复发 Sequel to acute pancreatitis 急性胰腺炎后遗症 Chronic recurrent pancreatitis慢性复发性胰腺炎 EPI 胰腺分泌不足 Diabetes mellitus 糖尿病 v???? v???? v???? · v??? v Acute Pancreatitis: Treatment 急性胰腺炎 治疗 Introduction 介绍 Understanding the pancreas 熟悉胰腺 Case examples 病例 Pancreatitis in dogs 犬的胰腺炎 Pancreatitis in cats 猫的胰腺炎 1 Understanding the Pancreas熟悉胰腺 Signalment 征象 9 year old，9岁 NF Crossbred 杂交 History Severe vomiting 严重呕吐 Abdominal pain 腹痛 Moderately obese 中度肥胖– 7/9 “Bonnie” Diagnosis = Pancreatitis 诊断 为 胰腺炎 “Bonnie” Pancreatic lipase = 601 ng/ml (2.2-102) 胰脂肪酶 Pancreatic rest and CV support 胰腺休息和CV支持 Allow spontaneous resolution自然恢复 Parenteral fluids 输液 Anti-emetics 止吐剂 Gut protectants 腸胃保护剂 Analgesia 止痛 Antibacterials? 抗生素？ Steroids? 类固醇类？ Surgery? 手术？ Nutritional support 营养支持 Pancreatitis– Treatment胰腺炎–治疗 Intravenous fluid therapy静脉输液 Crystalloids 晶体液 Colloids 胶体液 Plasma 血浆 Provides ‘anti-proteases’ 抑制蛋白酶 Pancreatitis – Treatment胰腺炎–治疗 Parenteral fluids 输液 IV Hartmann’s 静脉内输入Hartmann’s 液 2x maintenance 二倍维持量 Add加入 KCl @ 20 mmol/l “Bonnie”Treatment 治疗 Anti-emetics 止吐剂 0.5-1mg/kg im/sc q6-8h CRI 1-2mg/kg iv over 24h Analgesia 止痛 Essential part of treatment 首要治疗手段 Opioids are recommended 推荐使用鸦片类 Pethidine 哌替啶，度冷丁 Buprenorphine 丁丙诺啡 Treatment 治疗 Antibacterials 抗生素 Most cases of pancreatitis are sterile 大多数胰腺炎是无菌性炎症 Antibacterials indicated if abscessation 出现脓症时需使用抗生素 Also, can get bacterial translocation 同时，可造成细菌转位 Therefore, prophylactic AB use 因此，预防用抗生素 Cephalosporins or amoxicillin-clavulanate 头孢菌素类或阿莫西林－克拉维酸 Treatment 治疗 Antibiotic choices 抗生素选择 Parenteral 肠外 Gram - Gram + Aerobes anaerobes 需氧/厌氧 Corticosteroids 皮质类固醇 Controversial 有争议 But, may have deleterious effects 可能造成病情