重症急性胰腺炎继发感染及抗生素的合理应用
李德辉,孙备,哈尔滨医科大学附属第一医院肝胆胰腺外科 黑龙江省哈尔滨市 150001
通讯作者:孙备,150001, 黑龙江省哈尔滨市南岗区邮政街23号,哈尔滨医科大学附属第一医院肝胆胰腺外科. sunbei70@tom.com
电话: 0451-53600281 传真:0451-53670428
收稿日期:2005-05-08 接受日期:2005-05-30
摘要重症急性胰腺炎(SAP)病情凶险，并发症多，并发胰腺感染高达40-70%.SAP远期死亡的主要原因是继发感染，占SAP死亡总数的80%以上.随着对SAP病理生理的深入研究，抗生素的合理应用在SAP治疗中所起的重要作用日益受到关注，抗生素可有效减少SAP的死亡率和并发症.本文就SAP继发感染的病因、病原微生物、机制和抗生素应用的种类、给药方式、策略做一综述.
, 百拇医药
李德辉,孙备.重症急性胰腺炎继发感染及抗生素的合理应用.世界华人消化杂志 2005;13(13):1574-1576
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, CarterR, Di Magno E, Banks PA, Whitcomb DC,Dervenis C, Ulrich CD, Satake K, Ghaneh P,Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW.
International Association of Pancreatology.AIP Guidelines for the surgical management of acute pancreatitis.
Pancreatology 2002;2:565-573
, 百拇医药
2 Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acutenecrotizing pancreatitis: treatment strategy
according to the status of infection. AnnSurg 2000;232:619-626
3 Bassi C, Larvin M, Villatoro E. Antibiotic therapy for prophylaxisagainst infection of pancreatic necrosis in acute
pancreatitis. Cochrane Database Syst Rev 2003;4:CD002941
4 Pupelis G, Austrums E, Snippe K. Importance of a clinical protocolin the treatment of severe acute pancreatitis.
, http://www.100md.com
Zentralbl Chir 2002;127:975-981
5 Buchler P, Reber HA. Surgical approach in patient with acutepancreatitis: is infected or sterile necrosis an indication
in whom should this be done, when, and why?Gastroenterol Clin North Am 1999;28:661-671
6 Radman I, Kovacevic-Metelko J, Aurer I, Nemet D, Zupancic-Salek S,Bogdanic V, Sertic D, Mrsic M, Pulanic R,Gasparovic V, Labar B. Surgical resectionin the treatment of primary gastrointestinal non-Hodgkin'slymphoma:
, 百拇医药
retrospective study. Croat Med J 2002;43:555-560
7 Isenmann R, Rau B, Beger HG. Early sever acute pancreatitis:characteristics of a new subgroup.
Pancreas 2001;22:274-278
8 Isenmann R, Beger HG. Bacterial infection of pancreatitis necrosis:role of bacterial translocation, impact of antibiotic
treatment. Pancreatology 2001;1:79-89
, 百拇医药
9 Runzi M, Layer P. Nonsurgical management of acute pancreatitis. Useof antibiotics.
Surg Clin North Am 1999;79:759-765
10 Saidakhmedova ZT. Immunodulating activity of thymogen in acutepancreatitis. Vopr Pitan 2000;69:35-36
11 Kylanpaa-Back ML, Takala A, Kemppainen E, Puolakkainen P,Kautiainen H, Jansson SE, Haapiainen R, Repo H.
Cellar markers of systemicinflammation and immune suppression in patients with organ failure due tosevere acute
, http://www.100md.com
pancreatitis. Scand Gastroenterol 2001;36:1100-1107
12 Ammori BJ, Fitzgerald P, Hawkey P, McMahon MJ. The early increaseIn intestinal permeability and systemic
endotoxin exposure in patients is notassociated with systemic bacterial translocation: molecular investigationof
microbial DNA in the blood. Pancreas 2003;26:18-22
13 Chavez AM, Menconi MJ, Hodin RA, Fink MP. Cytokine-inducedintestinal ephithelial hyperpermeability: Role of nitric
, http://www.100md.com
oxide. Crit Care Med 1999;27:2246-2251
14 Ronco C, Tetta C, Mariano F, Wratten ML, Bonello M, Bordoni V,Cardona X, Inguaggiato P, Pilotto L, d'IntiniV,Bellomo R. Interpreting the mechanismof continuous renal replacement therapy in sepsis: the peakconcentration
hypothesis. ArtifOrgans 2003;27:792-801
15 Gebhardt C. Pancreaticojejunal anastomosis. Indication, techniqueand results.
, http://www.100md.com
Zentralbl Chir 2001;126(Suppl1):29-31
16 Shrikhande S, Friess H, Issengger C, Martignoni ME, Yong H, GloorB, Yeates R, Kleeff J, Buchler MW. Fluconazole
penetration into the pancreas. AntimicrobAgents Chemother 2000;44:2569-2571
17 孙备, 许军,姜洪池,李哈莉.重症急性胰腺炎感染的相关因素分析及其预防.中华肝胆外科杂志 2003;9:186-188
18 Kramer KM, Levy H. Prophylactic antibiotics for severe acutepancreatitis: the beginning of an era.
, http://www.100md.com
Pharmacotherapy 1999;19:592-602
19 Rahman SH, Ammori BJ, Holmfield J, Larvin M, McMahon MJ. Intestinalhypoperfusion contributes to gut barrier
failure in severe acute pancreatitia.J Gastrointest Surg 2003;7:26-35
20 Foitzik T, Faulhaber J, Hotz HG, Kirchengast M, Buhr HJ. Endothelinmediates local and systemicdisease sequelae
in severe experimental pancreatitis. Pancreas 2001;22:248-254
, 百拇医药
21 Hayashi J, Kawarada Y, Isaji S, Yokoi H, Higashiguchi T.Therapeutic effects of continuous intresrtergal antibiotic
infusion in experimental acutenecrotizing pancreatitis. Pancreas 1996;13:184-192
22 Takeda K, Matsuno S, Sunamura M, Kakugawa Y. Continuous regionalarterial infusion of proteaseinhibitor and
antibiotic in acute necrotizingpancreatitis. Am J Surg 1996;171:394-398
, http://www.100md.com
23 成明富, 李淑芳, 丁涤飞,陈玉明. CT介导下介入治疗胰腺炎.放射学实践 2000;15:183-184
24 Bhatia M, Brady M, Shokuhi S, Christmas S, Neoptolemos JP, Slavi J.Inflammatory mediators in acute pancreatitis.
J Pathol 2000;190:117-125
25 Mcnelis J, Soffer S, Marini CP, Jurkiewicz A, Ritter G, Simms HH,Nathan I. Abdominal compartment syndrome in
the surgical intensive care unit. AmSurg 2002;68:18-23
, 百拇医药
26 Hartwig W, Werner J, Muller CA, Uhl W, Buchler MW. Surgicalmanagement of severe pancreatitis including sterile
necrosis. J Hepatobiliary PancreatSurg 2002;9:429-435
27 Hartwig W, Maksan SM, Foitzik T, Schmidt J, Herfarth C, Klar E.Reduction in mortality with delayed surgical therapy
of severe pancreatitis. JGastrointest Surg 2002;6:481-487
编辑 王谨晖 审读 张海宁, 百拇医药( 李德辉, 孙 备)
通讯作者:孙备,150001, 黑龙江省哈尔滨市南岗区邮政街23号,哈尔滨医科大学附属第一医院肝胆胰腺外科. sunbei70@tom.com
电话: 0451-53600281 传真:0451-53670428
收稿日期:2005-05-08 接受日期:2005-05-30
摘要重症急性胰腺炎(SAP)病情凶险，并发症多，并发胰腺感染高达40-70%.SAP远期死亡的主要原因是继发感染，占SAP死亡总数的80%以上.随着对SAP病理生理的深入研究，抗生素的合理应用在SAP治疗中所起的重要作用日益受到关注，抗生素可有效减少SAP的死亡率和并发症.本文就SAP继发感染的病因、病原微生物、机制和抗生素应用的种类、给药方式、策略做一综述.
, 百拇医药
李德辉,孙备.重症急性胰腺炎继发感染及抗生素的合理应用.世界华人消化杂志 2005;13(13):1574-1576
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, CarterR, Di Magno E, Banks PA, Whitcomb DC,Dervenis C, Ulrich CD, Satake K, Ghaneh P,Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW.
International Association of Pancreatology.AIP Guidelines for the surgical management of acute pancreatitis.
Pancreatology 2002;2:565-573
, 百拇医药
2 Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acutenecrotizing pancreatitis: treatment strategy
according to the status of infection. AnnSurg 2000;232:619-626
3 Bassi C, Larvin M, Villatoro E. Antibiotic therapy for prophylaxisagainst infection of pancreatic necrosis in acute
pancreatitis. Cochrane Database Syst Rev 2003;4:CD002941
4 Pupelis G, Austrums E, Snippe K. Importance of a clinical protocolin the treatment of severe acute pancreatitis.
, http://www.100md.com
Zentralbl Chir 2002;127:975-981
5 Buchler P, Reber HA. Surgical approach in patient with acutepancreatitis: is infected or sterile necrosis an indication
in whom should this be done, when, and why?Gastroenterol Clin North Am 1999;28:661-671
6 Radman I, Kovacevic-Metelko J, Aurer I, Nemet D, Zupancic-Salek S,Bogdanic V, Sertic D, Mrsic M, Pulanic R,Gasparovic V, Labar B. Surgical resectionin the treatment of primary gastrointestinal non-Hodgkin'slymphoma:
, 百拇医药
retrospective study. Croat Med J 2002;43:555-560
7 Isenmann R, Rau B, Beger HG. Early sever acute pancreatitis:characteristics of a new subgroup.
Pancreas 2001;22:274-278
8 Isenmann R, Beger HG. Bacterial infection of pancreatitis necrosis:role of bacterial translocation, impact of antibiotic
treatment. Pancreatology 2001;1:79-89
, 百拇医药
9 Runzi M, Layer P. Nonsurgical management of acute pancreatitis. Useof antibiotics.
Surg Clin North Am 1999;79:759-765
10 Saidakhmedova ZT. Immunodulating activity of thymogen in acutepancreatitis. Vopr Pitan 2000;69:35-36
11 Kylanpaa-Back ML, Takala A, Kemppainen E, Puolakkainen P,Kautiainen H, Jansson SE, Haapiainen R, Repo H.
Cellar markers of systemicinflammation and immune suppression in patients with organ failure due tosevere acute
, http://www.100md.com
pancreatitis. Scand Gastroenterol 2001;36:1100-1107
12 Ammori BJ, Fitzgerald P, Hawkey P, McMahon MJ. The early increaseIn intestinal permeability and systemic
endotoxin exposure in patients is notassociated with systemic bacterial translocation: molecular investigationof
microbial DNA in the blood. Pancreas 2003;26:18-22
13 Chavez AM, Menconi MJ, Hodin RA, Fink MP. Cytokine-inducedintestinal ephithelial hyperpermeability: Role of nitric
, http://www.100md.com
oxide. Crit Care Med 1999;27:2246-2251
14 Ronco C, Tetta C, Mariano F, Wratten ML, Bonello M, Bordoni V,Cardona X, Inguaggiato P, Pilotto L, d'IntiniV,Bellomo R. Interpreting the mechanismof continuous renal replacement therapy in sepsis: the peakconcentration
hypothesis. ArtifOrgans 2003;27:792-801
15 Gebhardt C. Pancreaticojejunal anastomosis. Indication, techniqueand results.
, http://www.100md.com
Zentralbl Chir 2001;126(Suppl1):29-31
16 Shrikhande S, Friess H, Issengger C, Martignoni ME, Yong H, GloorB, Yeates R, Kleeff J, Buchler MW. Fluconazole
penetration into the pancreas. AntimicrobAgents Chemother 2000;44:2569-2571
17 孙备, 许军,姜洪池,李哈莉.重症急性胰腺炎感染的相关因素分析及其预防.中华肝胆外科杂志 2003;9:186-188
18 Kramer KM, Levy H. Prophylactic antibiotics for severe acutepancreatitis: the beginning of an era.
, http://www.100md.com
Pharmacotherapy 1999;19:592-602
19 Rahman SH, Ammori BJ, Holmfield J, Larvin M, McMahon MJ. Intestinalhypoperfusion contributes to gut barrier
failure in severe acute pancreatitia.J Gastrointest Surg 2003;7:26-35
20 Foitzik T, Faulhaber J, Hotz HG, Kirchengast M, Buhr HJ. Endothelinmediates local and systemicdisease sequelae
in severe experimental pancreatitis. Pancreas 2001;22:248-254
, 百拇医药
21 Hayashi J, Kawarada Y, Isaji S, Yokoi H, Higashiguchi T.Therapeutic effects of continuous intresrtergal antibiotic
infusion in experimental acutenecrotizing pancreatitis. Pancreas 1996;13:184-192
22 Takeda K, Matsuno S, Sunamura M, Kakugawa Y. Continuous regionalarterial infusion of proteaseinhibitor and
antibiotic in acute necrotizingpancreatitis. Am J Surg 1996;171:394-398
, http://www.100md.com
23 成明富, 李淑芳, 丁涤飞,陈玉明. CT介导下介入治疗胰腺炎.放射学实践 2000;15:183-184
24 Bhatia M, Brady M, Shokuhi S, Christmas S, Neoptolemos JP, Slavi J.Inflammatory mediators in acute pancreatitis.
J Pathol 2000;190:117-125
25 Mcnelis J, Soffer S, Marini CP, Jurkiewicz A, Ritter G, Simms HH,Nathan I. Abdominal compartment syndrome in
the surgical intensive care unit. AmSurg 2002;68:18-23
, 百拇医药
26 Hartwig W, Werner J, Muller CA, Uhl W, Buchler MW. Surgicalmanagement of severe pancreatitis including sterile
necrosis. J Hepatobiliary PancreatSurg 2002;9:429-435
27 Hartwig W, Maksan SM, Foitzik T, Schmidt J, Herfarth C, Klar E.Reduction in mortality with delayed surgical therapy
of severe pancreatitis. JGastrointest Surg 2002;6:481-487
编辑 王谨晖 审读 张海宁, 百拇医药( 李德辉, 孙 备)
