Takeda K, Matsuno S, Ogawa M, Watanabe S, Atomi Y
First Department of Surgery, Tohoku University School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai 980-8574, Japan.
J Hepatobiliary Pancreat Surg. 2001;8(3):216-20. doi: 10.1007/s005340170019.
We evaluated the usefulness of continuous regional arterial infusion (CRAI) of protease inhibitors and antibiotics in 156 patients with acute necrotizing pancreatitis (ANP) collected in a cooperative survey carried out in 1997 in Japan. The overall mortality rate was 18.6%, and the frequency of infected pancreatic necrosis was 12.8%. There was no significant difference in mortality rates between patients who received the protease inhibitor via CRAI and the antibiotics intravenously (group A) and patients who received both the protease inhibitor and the antibiotics via CRAI (group B), but the frequency of infected pancreatic necrosis was significantly lower in group B (7.6%) than in group A (23.5%). The mortality rate in patients in whom CRAI therapy was initiated within 48 h after the onset of ANP (11.9%) was significantly lower than that in patients in whom CRAI therapy was initiated more than 48 h after the onset (23.6%). These results suggested that CRAI of both protease inhibitors and antibiotics was effective in reducing mortality and preventing the development of pancreatic infection in ANP when initiated within 48 h after the onset of ANP.
我们评估了在1997年日本开展的一项合作调查中收集的156例急性坏死性胰腺炎（ANP）患者中，蛋白酶抑制剂和抗生素持续区域性动脉灌注（CRAI）的有效性。总体死亡率为18.6%，感染性胰腺坏死的发生率为12.8%。通过CRAI接受蛋白酶抑制剂并静脉使用抗生素的患者（A组）和通过CRAI同时接受蛋白酶抑制剂和抗生素的患者（B组）之间死亡率无显著差异，但B组感染性胰腺坏死的发生率（7.6%）显著低于A组（23.5%）。在ANP发病后48小时内开始CRAI治疗的患者死亡率（11.9%）显著低于发病后48小时以上开始CRAI治疗的患者（23.6%）。这些结果表明，蛋白酶抑制剂和抗生素的CRAI在ANP发病后48小时内开始时，对于降低死亡率和预防胰腺感染的发生是有效的。
