486例急性胰腺炎患者的抗菌药物应用评价  

Evaluation the application of antimicrobials in 486 patients with acute pancreatitis

作　　者：崔微艳[1] 徐海峰[1] 李勇[2] 颜骏[2] 蔡燕[2] 杨宏锋[2] 刘竞[2] 张清艳[2] 吉木森[2] 金兆辰[2] CUI Weiyan XU Haifeng LI gong YAN Jun CAI Yan YANG Hongfeng LIU Jing ZHANGQingyan JI Musen JIN Zhaochen(Department of Critical Care Medicine,Affiliated Wujin Hospital,Jiangsu University, Changzhou, 213017, China Department of Critical Care Medicine, Affiliated People＇s Hospital ,Jiangsu University)

机构地区：[1]江苏大学附属武进医院重症医学科,江苏常州213017 [2]江苏大学附属人民医院重症医学科

出　　处：《临床急诊杂志》2017年第9期664-668,共5页Journal of Clinical Emergency

摘　　要：目的:评价抗菌药物在急性胰腺炎(AP)治疗中的效果。方法:采用回顾性分析方法,收集2012-05-2014-05江苏大学附属人民医院消化内科、普外科及重症医学科收治的AP患者486例。记录AP患者的一般资料、病因、严重程度分层,给予常规治疗基础上详细记录抗生素干预方案、发生局部并发症及非药物性干预情况。结果:486例AP患者抗生素使用情况:未使用抗生素55例、环丙沙星联合甲硝唑81例、头孢菌素类308例、哌拉西林他唑巴坦26例、碳青霉烯类13例及其他类3例。疾病严重程度分层,环丙沙星联合甲硝唑、头孢菌素类组与未使用抗生素组相比较差异无统计学意义。环丙沙星联合甲硝唑、头孢菌素类组住院时间与未使用抗生素组相比较差异有统计学意义(P<0.05)。局部并发症方面,未使用抗生素组发生感染性坏死、假性囊肿等的概率未出现明显上升,需非药物性干预频次亦无明显上升,该组未出现死亡病例。尽管环丙沙星联合甲硝唑、头孢菌素类组间住院时间差异无统计学意义,但头孢菌素类组非药物性干预频次明显上升,差异有统计学意义(P<0.05)。结论:对于未使用抗生素组AP患者,在疾病严重程度上并不严重于环丙沙星联合甲硝唑、头孢菌素类等使用一般抗生素组,但在临床住院时间、局部并发症发生率及短期预后等方面并未出现明显恶化,提示既往部分AP患者,尤其是轻症AP患者可能未能从常规预防性使用抗生素中获益。Objective：To evaluate the effects of antibacterial drugs in the treatment of acute pancreatitis （AP）. Method： A total of 486 AP patients hospitalized in digestive,general surgery or critical care medicine department from May 2012 to May 2014 were studied through a retrospective analysis. The data of clinical features,etiology, and severity classification of AP according to ＂revision＂ Atlanta standard （2012） were collected. Detailed antibiotic intervention programs based on routine therapy, local complications and non--drug interventions were recorded. Result： The antibiotics distribution of 486 AP patients were divided into six groups described as below： 55 patients did not use any antibiotics,81 patients in ciprofloxacin/metronidazole group, 308 patients in cephalosporin group, 26 cases in piperacillin/tazobactam group, 13 cases in carbapenems group, and 3 cases in the others groups. Com- pared with unused antibiotic group, ciprofloxacin/metronidazole group, and cephalosporin group had no statistical difference in disease severity stratification. Ciprofloxacin/metronidazole group and cephalosporin group had a statistical significance compared with unused antibiotic group in the length of hospital stay （P〈0.05）. In terms of local complications,unused antibiotic group didn＇t have a higher incidence rate in infective necrosis, pseudocyst, and non-drug interventions,and this group didn＇t appear dead cases. Although there was no significant difference in length of hospital stay between ciprofloxacin/metronidazole group and cephalosporin group, the cephalosporin group had a higher frequency of non-drug interventions （P〈0.05）. Conclusion.. In the unused antibiotic group,al though the severity of disease was no more serious than the ciprofloxaein/metronidazole and cephalosporin group, the length of clinical hospital stay,incidence of local complications and short--term prognosis did not have a significant deterioration,which indicated that part of the AP patients, especially mild AP p

关 键 词：急性胰腺炎 抗生素 

分 类 号：R657.5[医药卫生—外科学]