Dexamethasone and dextran 40 treatment of 32 patients with severe acute pancreatitis

Abstract

AIM:Based on the pathogenesis of severe acute pancreatitis and our experimental studies, to investigate the effect of dexamethasone and dextran in treatment of patients with severe acute pancreatitis. METHODS:Thirty-two patients with severe acute pancreatitis were treated with 0.5-1 mg/kg per day dexamethasone for 3-5 d, and 500-1 000 mL/d of dextran 40 for 7 d, besides the routine therapy. RESULTS:After 4-8 h of treatment, abdominal pain began to be relieved; range of tenderness began to be localized in 27 patients. They were cured with nonsurgical treatment. Five of them were deteriorated, and treated with surgery. Four patients in this group died. CONCLUSION:Dexamethasone and dextran 40 block the pathologic process of severe acute pancreatitis through inhibition of inflammatory mediators and improvement of microcirculation disorders respectively.

Effects of Dexamethasone on Intercellular Adhesion Molecule 1 Expression and Inflammatory Response in Necrotizing Acute Pancreatitis in Rats

“…Only the severe necrosis found 6 hours after inducing AP was significantly reduced by Dx treatment regardless whether it was given before or after AP. This effect could be explained by some protective actions attributed to glucocorticoids, such as circulation improvement 44 and stabilization of protein cytoskeleton. 48 In summary, prophylactic and therapeutic Dx treatments down-regulated the ICAM-1 expression in pancreas and lung during AP induced in rats by NaTc.…”

Current Controversies in Fluid Resuscitation in Acute Pancreatitis

“…Four eventually died. 49 The investigators stated that high-dose dexamathasone when used for a short period can inhibit multiple inflammatory mediators without untoward adverse effects, and dextran helps in microcapillary disorders. Another study in Chinese literature demonstrated improved survival in a group of patients receiving greater amount of colloids and greater ratio of colloids to crystalloid fluids during the first 72 hours.…”

“…Besides facilitating the passage of erythrocytes through small vessels, they are also known to possess antiplatelet and antifibrin properties. 49 In animal studies, it has been shown that besides inhibiting the progression of pancreatic necrosis by enhancing the pancreatic microcirculation, the inflammatory mediators have less access to the acinus. 50 Furthermore, the reduced trypsinogen activation prevented acinar necrosis and distant organ damage.…”

Fluid Replacement Strategy in Severe Acute Pancreatitis

“…Experimental studies have shown that isovolemic hemodilution with hydroxyethyl starch or without plasmatic hemoglobin reduce mortality and preserves pancreatic microcirculation [8,26,27]. Studies in humans are not conclusive because based on a small number of patients [28].…”