防治重症急性胰腺炎感染的临床研究

A clinical study on infection prevention in patients with severe acute pancreatitis

目的 探讨防止重症急性胰腺炎 (SAP)后期感染的治疗方法 ,提高SAP后期治疗水平。方法 总结分析 1995～ 1999年和 2 0 0 0～ 2 0 0 1年 4月两个阶段共收治的 134例SAP病人的治疗效果。第 1阶段用常规保守治疗 ;第 2阶段采取尽早进食 ,肠内营养及口服肠道益生菌等措施治疗。结果 第 1阶段收治SAP后期 10 2例 ,感染发生 4 5例 (4 4 1% ) ,复发 5例 (4 90 % ) ,住院时间平均 5 6d ,死亡 11例 (9 8% )。第 2阶段收治 32例 ,感染 7例 (2 1 8% ) ,住院时间平均 38d ,复发 2例(6 2 5 % ) ,死亡 2例 (6 2 5 % )。结论 适度提前进食、肠内营养及口服肠道益生菌等治疗措施有助于降低SAP后期感染率 ,改善预后。

Objective To explore the appropriate strategy for prevention of infection in patients with severe acute pancreatitis (SAP). Methods The clinical data of 134 patients with SAP treated in our hospital from 1995 to 1999 and from 2000 to 2001 were retrospectively analyzed. Routine conservative management was performed in 102 patients in the first period (1995-1999) and special regimen aimed at attenuating gut barrier damage and bacterial translocation (BT) after SAP besides routine management was given to 32 patients in the second period (2000-2001). Results During the first period, 45 out of the 102 patients were hospitalized for 28-89 days (mean = 56 days) and 11 died. During the second period, infection occurred in 7 of the 32 patients. Two patients had a relapse and 2 died. The 32 patients were hospitalized for 21-59 days (mean = 38 days). Conclusions Treatment with bifidobacterium and lactobacillus mixture, enteral feeding and early eating are helpful for not only preventing secondary infection after SAP but also improving the prognosis of SAP.