急性胰腺炎感染的诊治进展及国内外指南解读

Advances in diagnosis and treatment of infection in acute pancreatitis and interpretation of guidelines

急性胰腺炎是临床上常见的急腹症,重症患者病死率高达30%,感染并发症被认为是导致其死亡的重要因素。近10年来,对急性胰腺炎诊疗方面有许多新认识及进展。2013年国际胰腺病学会与美国胰腺病学会根据最近循证医学证据联合制订了《急性胰腺炎治疗的循证性指南》,美国胃肠病学会发布了《急性胰腺炎治疗指南》,中国也发布了《中国急性胰腺炎诊治指南(2013,上海)》。各指南均不推荐对急性胰腺炎患者预防性应用抗生素。对于存在坏死性感染灶的患者,应使用有效通过血胰屏障的药物进行治疗。该文对上述指南中有关抗生素应用方面的内容进行了解读。

Acute pancreatitis （AP） is a common acute abdomen in clinic ,with a mortality rate up to 30% in severe cases. Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality. During the past decade, there have been new understandings and developments in the diagnosis and management of the disease. In 2013 ,the International Association of Pancreatology （IAP） and the American Pancreatic Association （APA） published their new guidelines “2013 IAP/APA Evidence-based Guidelines for the Management of Acute Panereatitis”, and the Amer- ican College of Gastroenterology （ACG） also published “American College of Gastroenterology Guideline ： Management of Acute Pancreatitis”, so did our country. Routine use of prophylactic antibiotics in patients with AP is not recommended. In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful. This paper presented the understanding of the part of antibiotic use in the three guidelines.