Laws H L, Kent R B
Department of Surgery, Carraway Methodist Medical Center, Birmingham, Alabama 35234, USA.
Am Surg. 2000 Feb;66(2):145-52.
Acute pancreatitis develops precipitously, changing the patient's condition from apparent good health to a critically ill status. Of patients who succumb, 80 per cent die from secondary infection in the pancreas-peripancreatic area. Infection supervenes in the second week or later after onset. Prophylactic antibiotic(s) appear to be helpful in avoiding, delaying, and/or lessening secondary sepsis. Once infection develops, treatment requires open debridement of necrotic material, drainage, and appropriate antibiotic therapy; or mortality will approach 100 per cent. Infecting organisms are commonly Escherichia coli, Klebsiella, Staphylococcus, Enterococcus, Bacteroides, and/or fungi. Antibiotics felt to be preferable for prophylactic therapy include 1) imipenem-cilastatin, 2) a quinolone + metronidazole, and 3) possibly an extended-spectrum penicillin. Treatment should be continued for 2 weeks or until recovery. Because fungus infections are occurring more often, prophylaxis with fluconazole may be warranted.
急性胰腺炎起病急骤，可使患者状况从看似健康迅速转变为危重症状态。在死亡患者中，80%死于胰腺及胰腺周围区域的继发性感染。感染在发病后第二周或更晚出现。预防性使用抗生素似乎有助于避免、延迟和/或减轻继发性脓毒症。一旦发生感染，治疗需要对坏死物质进行开放性清创、引流以及适当的抗生素治疗；否则死亡率将接近100%。常见的感染病原体为大肠杆菌、克雷伯菌、葡萄球菌、肠球菌、拟杆菌和/或真菌。预防性治疗首选的抗生素包括：1）亚胺培南-西司他丁，2）喹诺酮类+甲硝唑，3）可能还包括广谱青霉素。治疗应持续2周或直至康复。由于真菌感染越来越常见，可能有必要使用氟康唑进行预防。
