急性胰腺炎早期预防性应用抗菌药物的初探

How to Prophylactic Application Antimicrobial in the Early of Acute Pancreatitis

目的对急性胰腺炎(Acute pancreatitis, AP)早期预防性应用抗菌药物的初步探讨。方法选取我院2018年1月至2020年12月诊断为AP的消化内科、普外科及重症医学科的患者,随机分为两组,每组30例,一组为早期预防性应用抗菌药物组,即观察组,根据病情需要给予氟喹诺酮类或第3代头孢菌素加甲硝唑或奥硝唑的联合用药方案或单用碳青霉烯类;另一组为同等病情没有早期预防性应用抗菌药物组,即对照组,两组在一般状况、疾病严重程度、病因构成、患者年龄及性别等基线水平方面无统计学差异,其他治疗AP的方案一致,比较两组患者在治疗3、7、14 d后血淀粉酶值及临床症状的缓解情况,7、14 d后腹部影像学变化。结果显示高脂血症性AP 3 d时复查血淀粉酶似乎下降的幅度更明显,但无统计学意义;各种病因、不同严重程度、年龄的患者早期预防性应用抗菌药物观察组上腹部影像学的好转程度与对照组比较无明显优势,似乎效果略优,差异无统计学意义;临床症状的好转程度与对照组比较3 d时似乎效果略差,7 d时效果略优,但均无统计学意义。结论对于AP早期预防性应用抗菌药物未显示出明显效果。

Objective To investigate the preventive application of antibiotics in early stage of Acute pancreatitis(AP).Methods Patients diagnosed with AP in the Affiliated Hospital of Inner Mongolia Medical University from January 2018 to December 2020 in the Department of Gastroenterology, General Surgery and ICU were randomly divided into two groups, with 30 cases in each group. One group was the early prophylactic antibiotic application, namely the observation group. Fluoroquinolones or third-generation cephalosporins combined with metronidazole or ornidazole or carbapenems alone were given according to the need of the patient’s condition. The other group was the control group without early prophylactic use of antibiotics for the same disease, and the other treatment regimens for AP were the same. There were no statistically significant differences between the two groups in baseline levels of general condition, disease severity, etiological composition, age and gender of patients. The blood amylase value and the remisson of clinical symptoms of patients in the two groups were compared after 3,7 and 14 days of treatment, and the abdominal imaging changes after 7 and 14 days of treatment were compared.Results It showed that the decrease of blood amylase in patients with hyperlipidemia appeared to be more obvious after 3 days of AP reexamination, but there was no statistical significance. Compared with the control group, the improvement degree of upper abdominal imaging in the experimental group with early prophylactic application of antibiotics for patients with various etiologies, different severity and ages was not obvious, and the effect seemed to be slightly better, the difference was not statistically significant. Compared with the control group, the improvement degree of clinical symptoms seemed to be slightly worse at 3 days and slightly better at 7 days, but there was no statistical significance.Conclusion Early prophylactic use of antibiotics for AP does not show significant effect.