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題 名 | 開心手術後澱粉酶肌酸酐廓清率比之探討 |
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作 者 | 張昭雄; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 14:2 1981.06[民70.06] |
頁 次 | 頁91-100 |
關鍵詞 | 開心手術; 澱粉酶肌酸酐廓清率; |
語 文 | 中文(Chinese) |
中文摘要 | 手術後胰臟炎之機轉有甚多討論。本報告對44位開心手術後的病人做系列之澱粉酶肌酸酐廓清率比(CAM/CCR)之檢查,其中13例在開刀後CAM/CCR升高,但大部份(12例)於第三天回復正常範圍。因開心手術並無直接傷害到胰臟之可能性,因此CAM/CCR之升高應可排除直接傷害之因素。CAM/CCR升高之病例於體外循環較長者較多。因CAM/CCR之升高於診斷急性胰臟炎的特定性相當高,此研究顯示開心手術後部份病人有亞臨床胰臟炎,故開心手術後例l行使用鼻胃管本來雖為胃氣脹,但或許也有益於手術後胰臟炎的發生和治療。 |
英文摘要 | The amylase creatiriine clearance ratio (CAm/Ccr) is a more sensitive and more reliable index of acute pancreatitis than the serum amylase level, especially in the postoperative period, when decreased renal clearance of creatinine will lower urine and elevate serum amylase level. Serial CAm/Ccr estimations were undertaken in 44 adult patients undergoing open heart surgery, during a 6-month period in the Chang-Gung Memorial Hospital, for the assessment of postoperative pancreatitis. Because it occurs more commonly after upper abdominal surgery, postoperative pancreatitis has been though to be related to direct pancreatic trauma. Other etiologies have also been postulated to explain the rather frequent occurrence of postoperative pancreatitis in nonupper abdominal surgetiy. We, therefore, choose open heart patients for evaluating the incidence and possible pathogenesis of postoperative pancreatitis, in whom direct pancreatic trauma is absent. Using 4% as normal upper limit, 29.5% of the patients developed biochemical evidence of ancreatic damage following open heart surgery, but all patients were asymptomatic for pancreatitis, this would indicate that a significant number of patients may have had subclinical pancreatitis following open heart surgery. The raised CAm/Ccr was particularly noted in patients who had prolonged cardiopulmonary bypass, hypotension and coronary artery disease. This fact would indicate that ischemia or inadequate tissue perfusion of the pancreas may play an important role in the development of acute pancreatitis. We recommend serial estimations of CAm/Ccr as a routine investigation after open heart surgery to aid the early recognition of postoperative pancreatitis. These patients with raised CAm/Ccr have suffered from some degree of pancreatic damage and they should be carefully observed for development of the full clinical picture of acute pancreatitis. Treatment is supportive, including nasogastric suction and fluid-electrolyte supplement. Our use of the Levin tube postoperatively in all patients following open heart surgery perhaps is a beneficial routine. |
本系統中英文摘要資訊取自各篇刊載內容。