Mithöfer K, Fernández-del Castillo C, Ferraro M J, Lewandrowski K, Rattner D W, Warshaw A L
Department of Surgery, Massachusetts General Hospital, Boston, USA.
Gastroenterology. 1996 Jan;110(1):232-40. doi: 10.1053/gast.1996.v110.pm8536862.
BACKGROUND & AIMS: It is still unproven whether prophylactic antibiotics can reduce mortality from acute necrotizing pancreatitis (ANP). The aim of this study was to investigate whether antibiotic therapy can influence long-term outcome in ANP and how appropriate this therapy is.
ANP was induced in rats by standardized intraductal bile acid infusion and cerulein hyperstimulation. Serum trypsinogen activation peptide levels were used to verify comparable disease severity. Starting 6 hours after induction, animals randomly received saline (n = 60), 20 mg/kg imipenem (n = 62), or 10 mg/kg ciprofloxacin (n = 60) every 8 hours for 7 days. On day 7, half of each group was killed so a quantitative pancreatic bacteriology could be conducted. The other half was analyzed at 21 days for long-term mortality, late bacteriologic changes, abscesses, and pseudocysts.
Comparable trypsinogen activation peptide increases confirmed equally severe ANP in each group before treatment. Imipenem and ciprofloxacin significantly reduced the number of infected pancreatic specimens, bacterial counts, and identified species at 1 week. At 3 weeks, pancreatic infection prevalence was lower in animals treated with antibiotics; abscess formation was reduced and pseudocysts were smaller and less frequently infected. Survival was significantly improved by imipenem and ciprofloxacin.
Antibiotic treatment reduces early and late septic pancreatic complications and improves survival from experimental ANP.
预防性使用抗生素是否能降低急性坏死性胰腺炎（ANP）的死亡率仍未得到证实。本研究的目的是探讨抗生素治疗是否会影响ANP的长期预后以及这种治疗的适宜性如何。
通过标准化的胆管内胆汁酸灌注和蛙皮素过度刺激诱导大鼠发生ANP。血清胰蛋白酶原激活肽水平用于验证疾病严重程度的可比性。诱导后6小时开始，动物随机接受生理盐水（n = 60）、20 mg/kg亚胺培南（n = 62）或10 mg/kg环丙沙星（n = 60），每8小时给药一次，持续7天。在第7天，每组半数动物处死，以便进行胰腺定量细菌学检查。另一半在21天时进行分析，以观察长期死亡率、晚期细菌学变化、脓肿和假性囊肿情况。
治疗前各组可比的胰蛋白酶原激活肽增加证实了ANP的严重程度相同。亚胺培南和环丙沙星在1周时显著减少了感染的胰腺标本数量、细菌计数和鉴定出的菌种。在3周时，接受抗生素治疗的动物胰腺感染患病率较低；脓肿形成减少，假性囊肿较小且感染频率较低。亚胺培南和环丙沙星显著提高了生存率。
抗生素治疗可减少实验性ANP的早期和晚期感染性胰腺并发症并提高生存率。
