Isaji Shuji, Mizuno Shugo, Tabata Masami, Yamagiwa Kentaro, Yokoi Hajime, Uemoto Shinji
First Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
J Hepatobiliary Pancreat Surg. 2003;10(6):419-24. doi: 10.1007/s00534-002-0811-x.
In severe acute pancreatitis, sepsis mainly due to pancreatic or peripancreatic infection have emerged as the most serious complications and now accounts for more than 80% of deaths. Collective review of organisms associated with secondary pancreatic infection in patients with acute pancreatitis has revealed that most of them are intestinal flora. Several experimental studies including ours have revealed that acute pancreatitis promotes bacterial translocation (BT), which in turn leads to infection of the pancreas and septic complications. Prophylactic antibiotics given intravenously have been demonstrated to be beneficial in reducing the rate of pancreatic infection, but their survival benefit remains unclear. We have demonstrated that continuous regional arterial infusion (CRAI) of an antibiotic is more effective than intravenous administration in preventing pancreatic infection and improving survival, in a canine model of acute necrotizing pancreatitis. Our recent experimental study has revealed that CRAI of an antibiotic via the superior mesenteric artery (SMA) is effective in mitigating intestinal mucosal damage and preventing BT in acute pancreatitis, thereby improving survival. BT aggravates pancreatic necrosis and remote organ damage in acute pancreatitis, and SMA infusion of antibiotics is effective in preventing BT and is practical for clinical use.
在重症急性胰腺炎中，主要由胰腺或胰周感染引起的脓毒症已成为最严重的并发症，目前占死亡病例的80%以上。对急性胰腺炎患者继发性胰腺感染相关微生物的综合回顾显示，其中大多数是肠道菌群。包括我们的研究在内的多项实验研究表明，急性胰腺炎会促进细菌移位（BT），进而导致胰腺感染和脓毒症并发症。静脉给予预防性抗生素已被证明有助于降低胰腺感染率，但其对生存率的益处仍不明确。在急性坏死性胰腺炎的犬模型中，我们已经证明，抗生素持续区域动脉灌注（CRAI）在预防胰腺感染和提高生存率方面比静脉给药更有效。我们最近的实验研究表明，通过肠系膜上动脉（SMA）进行抗生素CRAI可有效减轻急性胰腺炎时的肠黏膜损伤并预防BT，从而提高生存率。BT会加重急性胰腺炎时的胰腺坏死和远隔器官损伤，而经SMA灌注抗生素可有效预防BT，且在临床上具有实用性。
