Neostigmine Treatment of Acute Pancreatitis Combined With Intra-abdominal Hypertension
Condition: Acute Pancreatitis; Intra-abdominal Hypertension
MeSH terms: Intra-Abdominal Hypertension; Pancreatitis; Hypertension
Intervention: Neostigmine Methylsulfate 1 MG/ML; Conservative treatment
Intervention description: The initial dose was 1mg, intramuscular injection(IM) once every 12 hours. If there is no defecation after 12 hours, the dose is increased to 1mg IM once every 8 hours; if there is no defecation after 24 hours, the dose is increased to 1mg IM once every 6 hours. If the abdominal pressure drops below 12mmhg, neostigmine will be stopped, otherwise it will be used continuously for 7 days.; Intragastric administration of paraffin oil, 50ml,once every 8 hours；gastrointestinal decompression with nasogastric tube and rectal tub; lycerin enema promotes defecation; patients with ascites undergo percutaneous puncture drainage. Other conservative medical treatment recommended by the guidelines.
Intervention MeSH terms: Neostigmine
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 80.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No
Keywords: Acute Pancreatitis; Intra-abdominal hypertension; Abdominal compartment syndrome; Curative Effect; Security; Neostigmine

Summary:

      Acute pancreatitis(A) often complicated with Intra-abdominal Hypertension. After the onset of
      acute pancreatitis, capillary leakage causing ascites,upper gastrointestinal tract
      obstruction and paralytic ileus leading to an elevated IAP, severe IAH leads to ACS with high
      mortality. Neostigmine is an anti-cholinesterase drugs, can enhance intestinal peristalsis,
      promote flatus defecation. The aim of this study was to determine the effect of neostigmine
      on reducing abdominal pressure and clinical prognosis in patients with AP by promoting
      intestinal peristalsis and defecation.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Age 18-70 year ;

          2. The diagnosis of acute pancreatitis according to the revised Atlanta classification.

          3. IAH is defined as IAP ≥ 12 mmHg by the World Society of Abdominal;Compartment Syndrome
             (WSACS);

          4. After 24 hours of conventional treatment(such as gastrointestinal decompression or
             percutaneous drainage of ascites), the IAP of AP patients with IAH was still ≥ 12
             mmHg;

          5. The onset time of acute pancreatitis was within 2 weeks;

          6. Signed the informed consent.

        Exclusion Criteria:

          1. Previous history of laparotomy;

          2. Mechanical ileus or abdominal hemorrhage were considered clinically;

          3. Those who have contraindications to neostigmine: 1) Patients with angina; 2)
             myocardial infarction; 3) ventricular tachycardia; 4) bradycardia; 5) acute
             circulatory failure; 6) epilepsy; 7) bronchial asthma; 8) mechanical intestinal
             obstruction; 9) urinary tract infarction; 10) hyperthyroidism; 11) serious arrhythmia;
             12) bladder operation; 13) intestinal fistula;

          4. Allergic to neostigmine;

          5. Pregnant or lactating patients.