Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko174510.18499/2070-478X-2024-17-3-137-146Review of literatureОбзор литературыResearch ArticlePathogenetic Aspects of the Choice of Drug Therapy in the Treatment of Acute PancreatitisПатогенетические аспекты выбора медикаментозной терапии в лечении острого панкреатитаhttps://orcid.org/0000-0001-9422-177666031952834834-4717EktovVladimir N.ЭктовВладимир Николаевич
Russian Federation

M.D., Professor of the Department of Specialized Surgical Disciplines, N.N. Burdenko

доктор медицинских наук, профессор кафедры специализированных хирургических дисциплин

ektov.vladimir@yandex.ruhttps://orcid.org/0000-0003-2584-0471580250218003357-4960KhodorkovskyMark A.ХодорковскийМарк Анатольевич
Russian Federation

M.D., Professor of the Department of Specialized Surgical Disciplines, N.N. Burdenko Voronezh State Medical University

доктор медицинских наук, профессор кафедры специализированных хирургических дисциплин

vgmi_30@mail.ruhttps://orcid.org/0009-0008-5217-20972241-6585KurkinAlexander V.КуркинАлександр Васильевич
Russian Federation

Ph.D., Assistant of the Department of Specialized Surgical Disciplines

кандидат медицинских наук, ассистент кафедры специализированных хирургических дисциплин

av_kurkin@mail.ruN.N. Burdenko Voronezh State Medical UniversityВоронежский государственный медицинский университет им. Н.Н. Бурденко180820241731371461110202327072024Copyright ©; 2024, Ektov V.N., Khodorkovskiy M.A., Kurkin A.V.Copyright ©; 2024, Эктов В.Н., Ходорковский М.А., Куркин А.В.2024Ektov V.N., Khodorkovskiy M.A., Kurkin A.V.Эктов В.Н., Ходорковский М.А., Куркин А.В.http://creativecommons.org/licenses/by-nc-nd/4.0https://vestnik-surgery.com/journal/article/view/1745

Difficulties in determining effective treatment tactics for acute pancreatitis are associated with a complex multifactorial pathophysiological mechanism of the disease development. The central part in the pathogenesis of acute pancreatitis is taken by disorders of pancreatic microcirculation. Regardless of the etiology, increasing changes in microcirculation enhance the degree of pancreatic ischemia, thus intensifying the systemic inflammatory response syndrome and resulting in multisystem organ failure. Initial treatment of patients with moderate-to-severe and severe acute pancreatitis combined with transient or persistent organ failure should be carried out in intensive care units. Currently, there are no drugs effective for the treatment of acute pancreatitis in clinical practice. Initial treatment of various forms of acute pancreatitis is essentially supportive and aimed at relieving pain, nausea and vomiting, infusion therapy and early enteral nutrition. Indications for the use of antibacterial therapy in necrotizing acute pancreatitis are cases of infected pancreatic necrosis confirmed by CT or fine-needle aspiration biopsy, or clinical suspicion of infecting necrotic accumulations. To assess the severity and treat patients with severe acute pancreatitis, coordinated work of a multidisciplinary team of specialists is necessary. In the early stage of severe acute pancreatitis, responsibility for coordinating such multidisciplinary work should be borne by specialists of the intensive care units, at a late stage (in 2 weeks), such a role should be played by surgeons, determining the tactics of treating complications of necrotizing forms of acute pancreatitis and the use of various options for invasive interventions.

Трудности определения эффективной лечебной тактики при остром панкреатите связаны со сложным многофакторным патофизиологическим механизмом развития этого заболевания. Центральную роль в патогенезе острого панкреатита играют нарушения микроциркуляции поджелудочной железы. Независимо от этиологии, нарастающие изменения микроциркуляции увеличивают степень ишемии поджелудочной железы, что усиливает синдром системного воспалительного ответа и формирует мультисистемную органную недостаточность. Первоначальное лечение больных с умеренно тяжелой и тяжелой формами острого панкреатита на фоне преходящей или стойкой органной недостаточности необходимо проводить в условиях отделений реанимации и интенсивной терапии. В настоящее время нет лекарственных средств, эффективных в клинической практике для лечения острого панкреатита. Первоначальное лечение различных форм острого панкреатита по своей сути носит поддерживающий характер и направлено на купирование болевого синдрома, тошноты и рвоты, инфузионную терапию и раннее энтеральное питание. Показаниями к применению антибактериальной терапии при некротизирующем остром панкреатите являются случаи подтвержденного при помощи КТ или тонкоигольной аспирационной биопсии инфицированного панкреонекроза или клинические подозрения на инфицирование некротических скоплений. Для оценки тяжести и проведения лечения пациентов с тяжелым острым панкреатитом необходима слаженная работа мультидисциплинарной команды специалистов. На ранней стадии тяжелого острого панкреатита ответственность за координацию такой мультидисциплинарной работы должны нести специалисты отделений реанимации и интенсивной терапии, на поздней стадии (позже 2 недель) такую роль должны играть хирурги, определяющие тактику лечения осложнений некротизирующих форм острого панкреатита и применения различных вариантов инвазивных вмешательств.

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