개정된 대한췌장담도학회 급성췌장염 임상진료지침: 초기 치료, 영양지원, 회복기 치료 = Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Initial Treatment, Nutritional Support, Convalescent Treatment

국문 초록 (Abstract)

급성췌장염의 초기 치료와 영양 및 회복기 치료에 대한 권고사항을 요약하면 다음과 같다. 초기 치료로 적절한 정맥내 수액 공급을 위해서 목표 지향적 치료(goal-directed therapy)를 권장하고, 치료 초기에 통증 조절을 적극적으로 고려해야 하며 예방적 항생제의 일률적인 사용은 권고되지 않는다. 그리고 급성 담석성 췌장염 환자에서 담도염이 있거나 담도 폐쇄가 지속되는 경우에는 조기에 내시경역행담췌관조영술(ERCP)을 시행해야 한다. 영양지원에서는 가능한 조기에 경구로 식이를 시작할 것을 권고하고, 경구 식이가 어려운 경우 경장관 식이를 고려할 수 있으며 경구 식이의 조성이나 형태는 환자가 식이 가능한 형태의 저지방 식이를 권장한다. 마지막으로 회복기 치료에서 담낭담석이 있는 경증의 급성 담석성 췌장염은 담낭절제술을 가능한 같은 입원 기간 내에 시행하고, 중증의 경우에는 염증반응이 충분히 해소된 후에 시행하는 것을 권장한다. 그리고 반복하여 재발하는 알코올성 급성췌장염에서는 금주 치료를 고려할 것을 권고한다.

다국어 초록 (Multilingual Abstract)

Initial and convalescent treatment of acute pancreatitis (AP) is important in order to improve the prognosis and prevent the recurrence in the patients with AP. Initial intensive treatment includes fluid therapy, pain control, antimicrobial therapy, endoscopic retrograde cholangiopancreatography (ERCP), and nutritional support. Goal-directed therapy is recommended for fluid therapy, and the routine use of prophylactic antibiotics is not recommended. In acute gallstone pancreatitis, urgent ERCP should be performed only in patients with cholangitis or persistent cholestasis. Early oral feeding is advisable as tolerated and enteral feeding via nasogastric or nasojejunal tube appear comparable. In convalescent treatment, cholecystectomy during the initial admission is advisable for mild biliary pancreatitis with gallstone as possible, and treatment against alcohol dependence is considerable for recurrent acute alcoholic pancreatitis. In this review, we recommend practice guidelines for initial treatment, nutritional support, and convalescent treatment.
Korean J Pancreas Biliary Tract 2022;27(1):22-31

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