McClelland P, Murray A, Yaqoob M, Van Saene H K, Bone J M, Mostafa S M
Renal Unit, Royal Liverpool Hospital.
Ann R Coll Surg Engl. 1992 Sep;74(5):329-34.
Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six patients treated before 1987 had serious infections (three Gram-negative, one fungal), compared with only one of nine patients treated with SDD (P < 0.05). Clinical signs of sepsis were evident for 62% of the pre-SDD period, compared with 39% of the period during SDD therapy (P < 0.001). Systemic antibiotic prescribing was reduced in the SDD group; however, mortality remained unaffected with only two patients surviving pre-SDD and three during SDD treatment. SDD reduces infection rates and sepsis in patients with acute pancreatitis and may help to improve the prognosis of this life-threatening condition.
1984年至1986年间，6例并发急性胰腺炎的急性呼吸衰竭患者（需机械通气至少3天）在重症监护病房接受治疗（机械通气中位时长为6天；范围为3 - 41天）。1987年至1989年间，9例类似患者接受治疗（机械通气中位时长为35天，范围为4 - 69天），并引入了肠道给予妥布霉素、多粘菌素和两性霉素以选择性净化消化道（SDD）的方案。1987年前接受治疗的6例患者中有5例发生严重感染（3例革兰阴性菌感染，1例真菌感染），而接受SDD治疗的9例患者中只有1例发生严重感染（P < 0.05）。在SDD治疗前，62%的时间段有明显的脓毒症临床体征，而在SDD治疗期间这一比例为39%（P < 0.001）。SDD组全身性抗生素的使用减少；然而，死亡率未受影响，SDD治疗前仅2例患者存活，SDD治疗期间有3例患者存活。SDD可降低急性胰腺炎患者的感染率和脓毒症发生率，并可能有助于改善这种危及生命状况的预后。
