Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA.
HPB (Oxford). 2013 Oct;15(10):822-7. doi: 10.1111/hpb.12140.
Evidence-based guidelines for the treatment of severe acute pancreatitis have been established. This study was conducted to investigate the hypothesis that deviation from guidelines occurs frequently.
With institutional review board approval, the outside medical records of patients with severe pancreatitis who were transferred to the study institution during the period from July 2005 to May 2012 were reviewed. Severe pancreatitis was defined using the Atlanta Classification criteria. Records were reviewed with respect to published guidelines defining the appropriate use of imaging, antibiotics and nutritional support.
A total of 538 patients with acute pancreatitis were identified. Of 67 patients with severe acute pancreatitis, 44 (66%) were male. The mean age of the patients was 55 years. Forty-five of 61 (74%) patients for whom relevant data were available were imaged upon admission, but only 15 (31%) patients were imaged appropriately by computerized tomography with i.v. contrast to assess the presence of necrosis or other complications. In patients for whom relevant data were available, prophylactic antibiotics were initiated in the absence of culture data or a specific infectious target in 26 (53%) patients. Total parenteral nutrition (TPN) was administered to 38 (60%) of 63 patients for whom relevant data were available; only 10 (17%) patients received enteric feeding. No nutritional support was provided to 15 (23%) patients.
Adherence to best practice guidelines in the treatment of severe pancreatitis is poor. The consistent application of current knowledge might improve outcomes in these patients.
已制定出针对重症急性胰腺炎治疗的循证指南。本研究旨在验证指南常被违背这一假说。
经机构审查委员会批准，回顾性分析 2005 年 7 月至 2012 年 5 月期间转至研究机构的重症胰腺炎患者的外院病历。采用亚特兰大分类标准定义重症胰腺炎。根据影像学、抗生素和营养支持的应用指南来评估记录。
共确定 538 例胰腺炎患者，其中 67 例为重症急性胰腺炎，44 例（66%）为男性，平均年龄 55 岁。61 例中 45 例（74%）入院时接受影像学检查，但仅 15 例（31%）行 CT 平扫+静脉造影评估坏死或其他并发症，符合指南要求。26 例（53%）无培养数据或明确感染灶的患者预防性应用抗生素。63 例中 38 例（60%）给予全肠外营养（TPN），仅 10 例（17%）给予肠内营养。15 例（23%）未给予任何营养支持。
重症胰腺炎治疗中遵循最佳实践指南的情况不佳。当前知识的持续应用可能改善此类患者的预后。
