重症急性胰腺炎胰腺感染的综合性预防及治疗  

The prophylaxis and treatment of pancreatic infection in severe acute pancreatitis

作　　者：朱斌[1] 孙家邦[1] 周继盛[1] 李非[1] 张钰鹏[1] 杨磊[1] 陈宏[1] 贾建国[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京100053

出　　处：《中华普通外科杂志》2001年第11期645-646,共2页Chinese Journal of General Surgery

基　　金：北京市卫生局重点学科资助项目

摘　　要：目的　探讨重症急性胰腺炎 (SAP)继发胰腺感染的综合预防措施及治疗。方法　本组 2 2 3例SAP均先行非手术治疗 ,采取促进胃肠道功能的恢复、应用抗生素、抗休克、预防多器官组织低灌注及低氧血症等多种措施预防胰腺感染。 1990～ 1994年 ,将胰腺感染作为手术指征并立即进行手术 ;1995～ 1999年 ,加强对胰腺感染的预防 ,特别注意早期促进胃肠道功能的恢复。延期手术 ,将晚期局限性胰腺感染作为手术指征。结果　本组 2 2 3例SAP中发生胰腺感染 2 3例 ( 10 3 % )。两个阶段的胰腺感染率分别为 12 4 %及 8 7%。胰腺感染局限者的病死率为 8% ( 1/ 13 ) ,低于胰腺感染未局限者的 5 0 % ( 5 / 10 ) ,P =0 0 3 5。结论　积极、有效的综合性预防措施及延期手术治疗有助于降低SAP继发性胰腺感染率及胰腺感染的病死率。Objective To explore the prophyl axis and the timing of operation for pancreatic infection in patients with sever e acute pancreatitis(SAP).Methods 2 23 patients with SAP were treated in ICU from 1990 to 1999. The measures adopted against pancreatic infection included fluid resuscitation, nutritional support, antibiotics and prevention of hypoxemia, hypoperfusion and gut barrier dysf unction etc. Indication for operation in SAP was early pancreatic infection from 1990 to 1994. From 1995 to 1999, drainage of pancreatic abscess or localized infection with debridement of necrotic tissues was adopted. Results 23 (10.3%) patients received operation due t o pancreatic infection. The morbidity rate (8.7%) of pancreatic infection betwe en 1995 to 1999 was lower than that (12.4%) between 1990 to 1994. The postoper ative mortality rate (8%) of pancreatic abscess or localized infection was lower than that (50%) of early pancreatic infection. Co nclusion Comprehensive prophylaxis of pancreatic infection a nd delayed operation for pancreatic abscess or localized infection are effective treatment of SAP.

关 键 词：胰腺炎 病灶感染 综合疗法 重症急性胰腺素 预防 

分 类 号：R657.51[医药卫生—外科学]