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目的：了解严密监测下治疗急性重型胰腺炎伴多器官功能损害患者的有效方法。方法：总结１９９２年５月～１９９６年４月收治的急性重型胰腺炎６３例，ＲＡＮＳＯＮ指标平均（６．４±１．７）项，ＡＰＡＣＨＥⅡ评分平均（２５．６±９．６）分。治疗采用中药“柴芩承气汤”加减以清热解毒，通里攻下，活血化瘀；适时进行手术清除胰腺及胰周坏死组织，充分引流；结合严密的生命体征和器官功能监测，早期预防和处理并发症，予机械通气，全胃肠外营养支持等综合措施。结果：４２例中药治疗，９例治愈，２９例中转手术，３例死亡，１例自动出院。４７例手术治疗，治愈或好转３９例，死亡８例。总病死率１７．５％。结论：通过严密监测并采取中西医非手术和手术疗法相结合的综合治疗措施，早期纠正全身病理生理紊乱和积极支持治疗，及时手术，能提高重型胰腺炎的治愈率，降低病死率。
OBJECTIVE: To understand the effective methods for the treatment of acute severe pancreatitis with multiple organ dysfunction under close monitoring. Methods: 63 cases of acute severe pancreatitis admitted from May 1992 to April 1996 were summarized. The average RANSON index was 6.4 ± 1.7 and the average APACHE Ⅱ score was 25.6 ± 9.6. Treatment with traditional Chinese medicine “Chaiqin Chengqi Decoction” addition and subtraction to detoxification, Tongli attack, blood circulation; timely surgery to clear the pancreas and peritoneal necrosis, full drainage; combined with close vital signs and organ function monitoring, early Prevention and treatment of complications, mechanical ventilation, total parenteral nutrition support and other comprehensive measures. Results: 42 cases of traditional Chinese medicine treatment, 9 cases were cured, 29 cases of transit surgery, 3 died, 1 case was discharged automatically. 47 cases were surgically treated, 39 cases were cured or improved, and 8 cases died. The total case fatality rate of 17.5%. Conclusion: By closely monitoring and taking the combination of non-surgical and surgical treatment of integrated Chinese and Western medicine, early correction of systemic pathophysiological disorders and active supportive care and timely surgery can improve the cure rate of severe pancreatitis and reduce the mortality rate.