[Therapeutic strategy for severe acute pancreatitis and pancreatic encephalopathy]

To investigate the clinical treatment of pancreatic encephalopathy (PE) complicated in severe acute pancreatitis (SAP) patients.

Clinical data of 22 PE cases in 326 SAP patients admitted from January 1987 to December 2006 were collected and analyzed retrospectively. The incidence, clinical manifestation and therapy methods of PE were discussed respectively.

All the cases were divided into 2 subgroups according to the changing of treatment strategy for SAP in the past 20 years. Thirteen cases of PE complicated in 114 SAP patients during the first decade (1987 - 1996) with the incidence of 11.4%, including eight early pancreatic encephalopathy (EPE) ones and five cases of delayed pancreatic encephalopathy (DPE). Only one patient survived and the mortality was 92.3%. During the second decade (1997 - 2006), nine cases of PE (all EPE) were observed in 212 SAP patients. The incidence was 4.2% and they all survived. Patients with PE usually presented with dysphoria, disturbance of orientation, lethargy, illusion and even coma. Physical examination of nerve system could find signs of meningeal irritation, increased intracranial pressure and elevated amylase in cerebrospinal fluid. Fungal infection and body fluid and metabolic disturbance frequently complicated in DPE patients. The total incidence was 6.6% (22/326) and mortality was 54.5% (12/22). Death mostly happened in the first ten years and all died with multiple organ failure.

Elimination of different causes would be effective to decrease the incidence and intensive cerebral resuscitation and nerve nutrition therapy in the early stage is very important to decrease the mortality.