Treatment revisited and factors affecting prognosis of severe acute pancreatitis

Table 1 Treatment regime of severe acute pancreatitis

CT grading	Treatment
Grade A-C	Octreotide 0.1 mg q8h (H) × 5-7 d
	Bulpleurum Peony Cheng Qi decoction bid × 5-7 d
Grade D-E	Octreotide 0.1 mg/25% glucose IV
	0.5 mg/5% glucose in saline 1000 mL/24 h
	thereafter 0.6 mg/5% glucose in saline 1000 mL/24 h × 5-7 d or more
	or Stilamin 6 mg/5% glucose in saline 1000 mL/24 h × 5-7 d
	Bulpleurum Peony Cheng Qi decoction 150 mL bid × 5-7 d
	Plasma 400 mL-600 mL stat, 200 mL on 2nd and 3rd day each
	Human serum albumin 10-20 g/d
	Low molecular weight dextran (-40) + Dan Shen liquid 16-20 mL/glucose water
	250 mL × 1-2 d, thereafter Dan Shen liquid in glucose in saline × 3-5 d
	Ciprofloxacin 0.2 g bid + Metronidazole 100 mL bid × 4 weeks
	or Imipenum 0.5 g q8h × 4 weeks
	Compound aminoacids 500-750 mL qd, Intralipid 10% 500 mL qd
	Fasting for food but not the herbal medicine
	Omeprazole 40 mg IV gtt. qd × 7 d,
	and then 20 mg per oral qd × 2-3 weeks
	No atropine or gastric decompression
	Calcium, potassium salts supplement with occasional magnesium salt

Table 2 Effects of Octreotide and the herbal medicinals

Drug	Effects
Octreotide	Inhibits release of CCK and pancreatic enzymes
(Sandostatin)[5]	Stimulates and activates macrophages, lowering endotoxin level[6]
	Blocks release of inflammatory cytokines[7]
	Redistributes intrapancreatic blood flow
	Attenuates the interaction of neutrophils and endothelial cells[8]
	Inhibits eicosanoid and products as PGI2, leucotrienes
	Relaxes Oddi’s sphincter
Bulpleurum	Inhibits secretion and activities of pancreatic enzymes
Peony	Stabilizes lysosomal membrane
Cheng Qi	Inhibits inflammatory cytokines, IL-1, IL-6, IL-8, and TNF-α;
decoction[5]	Inhibits vascular permeability[9]
	Increase peristalsis with purgating effect, expelling bacterial flora
	and endotoxin
	Protects gut mucosal barrier, preventing bacteria dislocation[10,11]
	Relaxes Oddi’s sphincter
	Reduces urea synthesis, promotes urinary excretion of urea and
	creatinine
	Has broad antibiotic spectrum, including B. Fragilis
	Stimulates secretion of endogenous glucocorticoids which can inhibit
	cytokines and inflammatory mediators
	Decreases blood lipids, inhibits lipid peroxidation
	Inhibits TXA2 synthase, promotes PGE1 PGE2 levels, inhibits
	transformation of fibrinogen to fibrin and prevents endotoxin
	induced DIC
Dan Shen	Inhibits platelet aggregation, decreases blood viscosity, improves
(Salvia	blood rheology and microcirculation
Miltiorrhiza)	Inhibits lysosomal enzymes and chemotactic neutrophils
	Blockage of calciumion influx
	Has antioxidation effect, ameliorates inflammation and tissue damage