目的 评价超声造影引导介入治疗在重症急性胰腺炎中的应用价值。方法 选取2020-01至2022-11就诊于武汉大学人民医院,诊断为重症急性胰腺炎患者98例,按是否进行介入治疗进行分组,分为引流组(n=51)和对照组(n=47)。两组予以吸氧、胃肠减压、抗感染、抗休克、纠正水电解质及酸碱失衡等同样治疗,引流组在上述治疗的基础上,于入院当天行超声引导下置管引流,引流组患者均先行常规超声检查,然后行超声造影检查病灶内部及周边,选择病灶内液化良好区域并设计穿刺路径,在病灶内置入引流导管,并确认导管位置置入正确,术后记录引流液体性质与量。通过两组置管前后临床指标的监测来评估病情变化,观察指标包括疗效的评估,腹内压和急性生理与慢性健康评分(APACHEII),肝肺功能监测以及入院后第3天、第5天、第10天炎性相关指标的对比。结果 引流组疗效明显优于对照组,引流组显效率50.98％(26/51),好转率41.18％(21/51),总有效率92.16％(47/51);对照组显效率34.04％(16/47),好转率40.43％(19/47),总有效率74.47％(35/47)。其引流组腹内压及APACHE II评分下降更为明显(P<0.001),炎性指标包括白细胞计数、血淀粉酶、血脂肪酶、C-反应蛋白、降钙素原,血钙均呈现下降趋势,且明显优于对照组,其中以入院后第5天两组间下降差异最为明显(P<0.05),引流组的肝功能及肺功能指标较对照组恢复较快,以入院后第3天及第5天AST、ALT下降、PaO₂、氧合指数上升更为明显(P<0.05)。结论 超声造影引导下置管引流术可有效治疗重症急性胰腺炎引发的相关并发症,可在较短时间内延缓患者病情进展,是目前临床上治疗重症急性胰腺炎有效手段之一。

Objective To evaluate the application value of contrast-enhanced ultrasound (CEUS)-guided interventional therapy in severe acute pancreatitis. Methods A total of 98 patients diagnosed with severe acute pancreatitis were selected from the People's Hospital of Wuhan University from January 2020 to November 2022, and divided into drainage group (n=51) and control group (n=47) according to whether interventional treatment was performed. The two groups were treated with oxygen inhalation, gastrointestinal decompression, anti-infection, anti-shock, correction of water, electrolyte and acid-base imbalance, etc. The drainage group received ultrasound-guided tube drainage on the day of admission on the basis of the above treatment. The patients in the drainage group underwent routine ultrasound examination first, underwent CEUS examination to examine inside and around the lesions, the puncture path was designed at the areas with good liquefication in the lesions, a drainage catheter was inserted into the lesion and the location of the catheter was confirmed to be correct, and the nature and amount of drainage fluid were recorded after surgery. The changes were evaluated by monitoring clinical indicators before and after catheterization in the two groups, including the evaluation of efficacy, intra-abdominal pressure, acute physiological and chronic health score (APACHEII), monitoring of liver and lung function, and comparison of inflammatory indicators on day 3, day 5, and day 10 after admission. Results The curative effect of the drainage group was significantly better than that of the control group. The effective rate of the drainage group was 50.98% (26/51), a recovery rate was 41.18% (21/51), and the total effective rate was 92.16% (47/51), while the effective rate of the control group was 34.04% (16/47), the improvement rate was 40.43% (19/47), and the total effective rate was 74.47% (35/47). The intra-abdominal pressure and APACHEII score of the drainage group decreased more significantly (P<0.001), and the inflammatory indexes including white blood cell count, blood amylase, blood lipase, C-reactive protein, procalcitonin, and blood calcium showed a downward trend after surgery, and were significantly better than the control group, with the most significant difference between the two groups on the 5th day after admission (all P<0.05). The liver and lung function of the drainage group recovered faster than the control group, and AST, ALT, PaO₂ and oxygenation index increased more significantly on the 3rd and 5th day after admission (P<0.05). Conclusions CEUS-guided catheter drainage can effectively treat complications associated with severe acute pancreatitis and temporally delay disease progression, thus serving as an effective approach in clinical treatment of severe acute pancreatitis.