Do you know the normal value of serum amylase?

Serum amylase is an important criterion for judging physical health. Its normal value is between 40 and 110 U. People need to have a full understanding of this. Only in this way can people better judge their own physical condition. If people find that their serum amylase exceeds or is lower than the normal value during examination, they need to seek medical treatment in time to avoid causing a series of diseases and restore a healthy physique as soon as possible.

1. Normal value of serum amylase

40-110U (Somogyi). More than 500u indicates acute pancreatitis. However, in cases of acute pancreatitis, 1/3-2/3 of serum amylase may be below 500u. Especially in severe pancreatitis, serum amylase may be within the normal range. Serum amylase often increases within 2-12 hours after onset and returns to normal after 48-72 hours. At this time, urine amylase should be measured, preferably the total amount of amylase in two hours of urine. When the urine amylase exceeds 300U per hour, the accuracy of diagnosis can be doubled. Most cases of acute pancreatitis are mild and can be cured with 3 to 5 days of active treatment.

2. Treatment measures :

① Fasting; ② Gastrointestinal decompression; ③ Intravenous infusion, actively replenish blood volume, maintain water, electrolyte and acid-base balance, and pay attention to maintaining heat supply; ④ Analgesic treatment: Pethidine can be given to patients with severe abdominal pain; ⑤ Antibiotics: Since acute pancreatitis is a chemical inflammation, antibiotics are not necessary; however, acute pancreatitis in my country is often related to biliary diseases, so it is customary to use them clinically; if concurrent infection is suspected, 1 to 2 antibiotics must be selected; ⑥ Acid suppression therapy: In the past, routine application was emphasized, and it is still customary in clinical practice; such as (intravenous H2 receptor antagonists or proton pump inhibitors), which can prevent stress ulcers.

Other treatments

Comprehensive measures must be taken for severe pancreatitis, and active rescue and treatment should be carried out. In addition to the above treatment measures, the following measures should also be taken:

1. Medical treatment

1. If conditions permit, the patient should be transferred to the Intensive Care Unit (ICU). Take appropriate measures to address organ failure and metabolic disorders. For example, closely monitor blood pressure, blood oxygen, urine volume, etc.;

(ii) Maintain water and electrolyte balance and blood volume. Actively replenish fluids and electrolytes (potassium, sodium, calcium, magnesium and other ions) to maintain effective blood volume. Severely ill patients often suffer from shock and should be given albumin, fresh blood, or plasma substitutes.

(III) Nutritional support is particularly important for patients with severe pancreatitis. In the early stage, total parenteral nutrition (TPN) is generally used; if there is no intestinal obstruction, jejunal intubation should be performed as soon as possible and transition to enteral nutrition (EN). Nutritional support can enhance the intestinal mucosal barrier and prevent intestinal bacterial translocation from causing pancreatic necrosis and infection.

(IV) Antibiotics are routinely used in severe pancreatitis to prevent pancreatic necrosis and infection. The selection of antibiotics should consider: ① Antibiotics that are sensitive to intestinal translocated bacteria (Escherichia coli, Pseudomonas aureus, Staphylococcus aureus, etc.); ② Antibiotics that have good pancreatic penetration: such as imipenem or quinolones, etc., and combined use of drugs that are effective against anaerobic bacteria (such as metronidazole). Second and third generation cephalosporins may also be considered.

(V) Reduce pancreatic juice secretion. Somatostatin has the effect of inhibiting the secretion of pancreatic juice and pancreatic enzymes, and inhibiting the synthesis of pancreatic enzymes. Somatostatin and its analog octapeptide (octreotide) have good therapeutic effects. It can also relieve abdominal pain, reduce local complications and shorten hospitalization time. The first dose is 100 μg intravenous injection, and then somatostatin/octreotide is continuously intravenously dripped at 250 μg/25-50 μg per hour for 3-7 days. Although the efficacy has not yet been finally determined, most domestic scholars currently recommend using it as early as possible.

(VI) Inhibition of pancreatic enzyme activity is only used in the early stages of severe pancreatitis, but its efficacy remains to be confirmed. Aprotinin can resist pancreatic kallikrein, preventing bradykininogen from turning into bradykinin, and can also inhibit protease, chymotrypsin and serotonin, 200,000 to 500,000 U/d, dissolved in glucose solution and intravenously dripped in 2 times; fluorouracil can inhibit DNA and RNA synthesis, reduce pancreatic juice secretion, and has an inhibitory effect on phospholipase A2 and trypsin, 500 mg per day, added to 500 ml of 5% glucose solution and dripped intravenously. Gabexate (FOY) can inhibit proteases, kallikrein, prothrombin, elastinase, etc. Depending on the condition, 100-300 mg per day can be dissolved in 500-1500 ml of glucose saline and dripped intravenously at a rate of 2.5 mg/(kg.h). The condition will improve in 2 to 3 days and the dosage can be gradually reduced.

2. Endoscopic sphincterotomy (EST) can be used for emergency decompression, drainage and removal of gallstone obstruction in the bile duct for biliary pancreatitis. As a non-surgical treatment, it plays a role in treating and preventing the development of pancreatitis. It is suitable for elderly people who are not suitable for surgery and must be performed by experienced endoscopists.

3. Traditional Chinese medicine has certain effect on acute pancreatitis. The main ingredients include: bupleurum, coptis, phellodendron, immature bitter orange, magnolia bark, costusroot, white peony root, sodium glabra, rhubarb (added later), etc., which can be added or subtracted according to symptoms.

4. Surgical treatment

(1) Peritoneal lavage: Peritoneal lavage can remove bacteria, endotoxins, pancreatic enzymes, inflammatory factors, etc. in the abdominal cavity, reducing the damage of these substances to organs throughout the body after entering the blood circulation.

(II) Indications for surgery include: ① when the diagnosis is unclear and it is difficult to differentiate from other acute abdominal diseases such as gastrointestinal perforation; ② when severe pancreatitis is not responsive to medical treatment; ③ when pancreatitis is complicated by abscess, pseudocyst, diffuse peritonitis, intestinal paralysis and necrosis; ④ when biliary pancreatitis is in an acute state and requires surgical operation to relieve the obstruction.