MAP MAP 2.3 AP MSAP 48h TNF-α IL-6 / IL-8 3 SAP 48h SIRS SAP SIRS SAP SAP MSAP AP 36%~50% systemic inflammatory response syndrome SIRS 3, [1] / Marsha

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1 50 severe acute pancreatitis SAP 2.1 AP 4.9~73.4/10 SAP SAP AP 40/10 70/10 20 PubMed Medline 0.19% 0.71% [1-3] SAP 30%~50% [4] AP 10 0~9 0 9 AP AP ± % 18.2% [5] AP acute pancreatitis AP 50 g/d 5 AP AP AP SAP SAP 25%~35% SAP AP ERCP AP SAP idiopathic acute pancreatitis IAP IAP SAP SAP CT SAP 1 IAP Oddi 1131

2 MAP MAP 2.3 AP MSAP 48h TNF-α IL-6 / IL-8 3 SAP 48h SIRS SAP SIRS SAP SAP MSAP AP 36%~50% systemic inflammatory response syndrome SIRS 3, [1] / Marshall 2 Marshall 2012 AP [6-7] acute respiratory distress syndrome ARDS 2013 AP 2 Marshall AP ICU SOFA [6] [6] 2.4 AP AP AP 3 2 : 1 AP AP h / 3 CT 48h / AP MSAP 3 SAP AP SAP CT 2.5 AP AP 24h 48h 7 [6] AP CT / AP [7-8] AP 1 Ranson Balthazar CT CT- SI CT AP : 5%~10% BISAP HAPS, 2009 [7-8] AP JPN Severity Score JSS 1 BISAP Mounzer [9] 2.6 RansonBISAP HAPS JSS 48h [6] AP 3 MAP 1 MSAP 1 MAP: 1.1 AP / Marshall 1132

3 8.09±0.95 EUS MRCP 5mm h 7 AP /CT ERCP 7.43±2.27 ERCP /CT [11] EUS 5mm MRCP EUS ERCP [12] MRCP EUS ERCP AP [13] ERCP ERCP 1 ERCP 2 ERCP 3 ERCP [15] ERCP 4 [14] ERCP 1 MAP [ ] 2 [16] 3 80 [18] 4 [19-20] CT CT MRCP EUS 6.74±1.96 [10] MRCP EUS ERCP 8.52±0.59 magnetic resonance cholangiopancreatography, MRCP 2.3 endoscopic ultrasonography EUS ERCP 7.30±1.15 MRCP 2.4 ERCP ERCP 1133

4 [23] /CT 7.13± hyperlipidemia in acute pancreatitis, HLAP AP TG 11.3mmol/L HLAP [21] HLAP TG AP [22] TG [24] TG TG 11.3mmol/L HLAP TG [5], [25] plasma exchange PE , double filtration plasmapheresis, DFPP HLAP 3 PE DFPP PE PE 3.1 TG TG >11.3 mmol/l 7.91±1.31 PE 3.2 TG 2.5L/h 2 000~3 000ml PE DFPP 4h 3~5d DFPP 3.4 ERCP 1 ERCP 100mg [26-28] ERCP post-ercp pancreatitis, PEP PEP 5-Fr TG DFPP 250μg [29] 100~120ml/min 20~25ml/min 2 ERCP 60~75ml/h 0 3 4h DFPP PE 4.8 TG HLAP 7.30± Fr 150~210ml/min 2~2.5h 5-Fr ERCP 12~24h TG 5 ERCP 1134

5 [30] 1min 20 U 3 /d ERCP AP ICU 1 SAP 2 PEP AP SAP ICU 1 24h 5.91±1.86 APACHE h SIRS ERCP 44% BUN 20mg/dl 6.74± 1.8mg/dl h AP 4.1 SAP SAP SpO 2 48~72h multidisciplinary treatment MDT SAP 180~200mg/dl [8 ICU ] MDT 5 MDT 5.1 SAP 8.65± MDT SAP 7.00± % 8.3% 3 10% 5.3 AP ICU SAP SAP SAP SAP [8 21] CT [32] [33] 2 intraabdominal hypertension IAH abdominal compartment syndrome ACS [35] [34] Oddi percutaneos catheter drainage PCD PCD CT H 2 CT H SAP [8 21] AP 8.04±1.07 PCD video assisted retroperitoneal debridement VARD [36] [32] SAP A / PCD 1135

6 [37] [38-39] 48%~56% ACS SAP ACS [40] PCD 10~14d CT 75% MODS 75% ACS SAP SAP ACS 28~30-Fr [41] PCD B CT [49] SAP ACS [50-52] Seldinger technique [42] / [53] PCD 4 SAP IAP 12mmHg, [43] [44] 6 ACS IAP IAP 15mmHg SAP 7 MDT 7.1 IAH SAP SAP 8.39± SAP ACS 7.48±1.95 ACS 4.3 IAH ACS IAH 7.52± mmHg ACS 4.4 SAP 20mmHg 60mmHg 1/3 [35-45] [54-55] SAP SAP IAH ACS 6 RCT 40% 10% AP ACS Meta SAP van Brunschot 47.5% ACS SAP 72h [8] ACS 24.0%~66.7% IAH SAP MODS [46-48] [14 SAP 21 32] SAP CT ACS SAP ACS 20mmHg 1136

7 10~20kcal/h 500kcal/d SAP 25~30kcal kg -1 d ~2.0g kg -1 d -1 EN [56] [63] EN 15mmHg CRP 15mmHg EN [57] [64-65] CT continuous renal replacement CT therapy, CRRT fine needle aspiration, FNA 2.5g kg -1 d -1 [66] EN5~7d PN EN Petrov [67] [58] SAP [68] CT SAP [36] FNA [32] [69] CT SAP EN [70] [59] EN MIC [59-60] [66] AP 1 EN EN 60% PN PN [61] [57] SAP ± SAP SAP ± SAP EN enteral nutrition, EN MODS parenteral nutrition, PN [62] MSAP 24~ EN AP EN [62] 48h EN 1137

8 9.2 SAP 1 EN EN pulmonary capillary wedge pressure PWCP 60% PN PN 7.43±1.31 CVP 4.6 Swan-Ganz [75-77] SAP SAP [72] SAP SAP SAP AP SAP Beger [73] SAP MODS [78] 2 24h SAP 5~10ml kg -1 h -1 30~45min 20ml/kg / =3/1 ACS 0.5~1ml kg -1 h -1 mean arterial pressure MAP 65mmHg 1mmHg=0.133kPa 120 /min BUN 7.14mmol/L BUN 7.14mmol/L 24h SAP 1.79mmol/L Hct 35%~44% 24~48h 8~12h 1 1~2 SAP SAP CVP PWCP left ventricular end-diastolic volume LVEDV Hct noninvasive hemo- [71] dynamic monitoring SAP EN SpO 2 PN [74] 24~48h invasive hemodynamic 9 monitoring 9.1 SAP EN central venous 7.70±1.33 pressure CVP 1138

9 SvO 2 AP SpO 2 94%~98% CO 2 SpO 2 88%~92% [79] CVP SpO 2 3% CVP CVP LVEDV CVP AP SAP 5L/min 8.00± L/min 7.57± SAP AP 75% AP [80] HFNC [83] HFNC AP HFNC ARDS continuous positive ventilator-associated events, VAE airway pressure, CPAP AP AP ARDS HFNC [81] IAH AP [84-86] AP IAH 20 RR 28 /min SpO 2 / FiO ARDS [82] AP SpO 2 SpO 2 SpO 2 CO 2 CPAP 1139

10 nonin- vasive positive pressure ventilation, NIPPV IAH NIPPV 3 1Vt Pplat ARDS Vt 5~8ml/kg Vt 6ml/kg 4ml/kg 30 /min NIPPV Vt HFNC 1~2h 30cmH 2O 2 positive end expiratory pressure, [89] PEEP AP 6~12cmH 2 O AP SAP PEEP PEEP [90] IAP 3 RR Vt CO 2 1 RR 35 /min RR PEEPi 2 VAP cmH 2 O 0cmH 2O Vt/ Crs [91] 4 SAP ARDS 5 SAP ICU Y 34~41 100% SAP 37 SAP 20~ Y 6.87± SAP 1~2h [87] 1 AP 6.35±2.14 ARDS 11.3 ARDS 7.39± IAH AP A/C 4.8 CRRT extracorporeal membrane oxygenation, ECMO SAP CRRT [88] PSV NAVA PAV ECMO 1140

11 4.8.1 SAP CRRT MODS 35ml kg -1 h ml kg-1 h CRRT CRRT d [98] [99] CRRT 24h SAP ml/12h 50ml/12h 25~35ml kg-1 h BUN 30mmol/L ph 7.1 K + 6.5mmol/L Na + 160mmol/L CRRT CRRT 115mmol/L 40 CRRT [100] Hb 60g/L SAP [101] CRRT SAP SIRS CARS SAP CRRT CRRT 48~72h HVHF MODS SIRS 5.96±1.99 CARS SAP 12.2 SAP CRRT SIRS 48~72h 6.04±2.29 [92-94] SAP ECMO ARDS 24~48h TG 1 000mg/dl SAP 50% CRRT ARDS 80% [102] SAP CRRT SAP CRRT [103] continuous intravenous-vein hemofiltration mode, CVVH 2009 CESAR ECMO continuous venous blood dialysis filter, CVVHDF high volume 2012 ARDS hemofiltration, HVHF ECMO ARDS peritoneal dialysis, PD ELSO ARDS ECMO 53% 250~300ml/ min 4 000ml/h 12~ ECMO 24h 72h ECMO SAP APACH [95] ACS [96] 1993 Anderson ARDS ECMO RENAL [97] acute SAP ECMO kidney injury, AKI 40ml kg -1 h -1 63%~100% [ ] ARDS 25ml kg -1 h -1 28d 90d ECMO SAP 2013 IVOIRE AKI ECMO SAP VA-ECMO 1141

12 50%~100% ECMO SAP SAP SIRS SAP ACS [106] ARDS ECMO SAP 100 NRS VAS P A -B O 2 600mmHg 35 /mm ph cmH 2O 65 CPOT RASS 7d SAS ICU [107] ECMO 1 CAM-ICU 50% 2 3 CI 2L/ m 2 min MAP SAP 1 60mmHg 3h 5mmol/L 0.5ml kg -1 h -1 5h SAP ECMO ECMO SAP NSAIDs [ ] [113] ECMO [114] ECMO SAP Bryner [105] 8 SAP 5 ECMO 1 PLT /L 2 ACT 2012 ipad 170s 3 4 Amicar 24h 5 HLAP ECMO SAP 3d TG 5.13±2.12 [ ] BPS [111] [112] 2 TG 11.3mmol/L AP [115] [116] 13.2 ECMO ECMO pancreatic encephalopathy PE SAP 6.78±2.28 ICU SAP 4.9 SAP SAP SAP [117] SAP 7.83±1.15 Oddi

13 HLAP 7.17± SAP 7.17± PN 5.1 PN [123] [118] EN [124] [119] [125] [126] [120] Over The Scope Clip [118] OTSC PN 1cm EN [121] SAP 7.83± PN PE 7.57± ± ± [127] 1.2%~14.5% [122] 1143

14 SAP 15%~60% [128] 29.7% 34% [ ] [131] 1 SAP SAP [130] [ ] 2 0.5ml/ min 3 SAP [128] 4 Wipple 45% SAP SAP 6 SAP SAP 7.52± SAP Hb 2g/ 7.52±1.38 dl 5.3 AGI SAP AGI ACS AGI MODS MRI CT AGI [130] SAP 24~48h EN AP SAP AGI IAH IAP 12~15mmHg EN 72h 20kcal/ 1144

15 kg BW/d [137] EN EN SAP VTE AGI 1 15~20mmHg LMWH LDUH VTE APP 60mmHg 2 30 SAP deep vein thrombsis, DVT EN AGI 2016ACCP [138] AGI MODS DVT 1 DVT DVT DVT LDUH LMWH AGI DVT DVT IVCF [135] IVCF DVT DVT IVCF DVT IVCF 4 DVT [136] g 12h SAP AGI 7.78± AGI 6.04± VTE VTE SAP Caprini 2 Pauda VTE ACCP [139] VTE ACCP [138] 1145

16 1 SAP 90mmHg 2 3 rt-pa U kg -l 2 h -1 2 rt-pa 50~100mg 2 h 1 rt-pa 2 rt-pa 1h 50mg 2h 50mg 3 2~4h APTT 2 80s ECMO ECMO [140] SAP VTE 7.04± SAP 6.26± ECMO 5.57± SAP 1146

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