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目的:评价抗菌药物在急性胰腺炎(AP)治疗中的效果。方法:采用回顾性分析方法,收集2012-05-2014-05江苏大学附属人民医院消化内科、普外科及重症医学科收治的AP患者486例。记录AP患者的一般资料、病因、严重程度分层,给予常规治疗基础上详细记录抗生素干预方案、发生局部并发症及非药物性干预情况。结果:486例AP患者抗生素使用情况:未使用抗生素55例、环丙沙星联合甲硝唑81例、头孢菌素类308例、哌拉西林他唑巴坦26例、碳青霉烯类13例及其他类3例。疾病严重程度分层,环丙沙星联合甲硝唑、头孢菌素类组与未使用抗生素组相比较差异无统计学意义。环丙沙星联合甲硝唑、头孢菌素类组住院时间与未使用抗生素组相比较差异有统计学意义(P<0.05)。局部并发症方面,未使用抗生素组发生感染性坏死、假性囊肿等的概率未出现明显上升,需非药物性干预频次亦无明显上升,该组未出现死亡病例。尽管环丙沙星联合甲硝唑、头孢菌素类组间住院时间差异无统计学意义,但头孢菌素类组非药物性干预频次明显上升,差异有统计学意义(P<0.05)。结论:对于未使用抗生素组AP患者,在疾病严重程度上并不严重于环丙沙星联合甲硝唑、头孢菌素类等使用一般抗生素组,但在临床住院时间、局部并发症发生率及短期预后等方面并未出现明显恶化,提示既往部分AP患者,尤其是轻症AP患者可能未能从常规预防性使用抗生素中获益。
Objective: To evaluate the efficacy of antibacterials in the treatment of acute pancreatitis (AP). Methods: A retrospective analysis was performed to collect 486 AP patients admitted to Department of Gastroenterology, General Surgery and Critical Care Medicine from the Affiliated People’s Hospital of Jiangsu University from May 2012 to May 2014. Record AP patients with general information, etiology, severity stratification, given routine treatment based on detailed records of antibiotic intervention programs, the occurrence of local complications and non-drug intervention. RESULTS: The antibiotic use in 486 patients with AP was 55 without antibiotics, 81 with ciprofloxacin plus metronidazole, 308 with cephalosporins, 26 with piperacillin and 25 with carbapenems Cases and other cases in 3 cases. Disease severity stratification, ciprofloxacin combined with metronidazole, cephalosporins and no antibiotics group compared with the difference was not statistically significant. Ciprofloxacin combined with metronidazole, cephalosporin group hospital stay and antibiotics group compared with no significant difference (P <0.05). In terms of local complications, there was no significant increase in the probability of occurrence of infectious necrosis, pseudocyst in the unused antibiotics group, and no significant increase in the frequency of non-medical intervention. No deaths occurred in this group. Although there was no significant difference in hospitalization time between ciprofloxacin and metronidazole and cephalosporins, the frequency of nonpharmacological intervention in cephalosporin group was significantly increased (P <0.05). CONCLUSIONS: For the patients without antibiotic AP, the severity of the disease is not serious with ciprofloxacin combined with metronidazole, cephalosporins and other general antibiotics group, but in the clinical hospital stay, the incidence of local complications and Short-term prognosis and other aspects did not show significant deterioration, suggesting that some patients with AP in the past, especially patients with mild AP may not benefit from routine prophylactic antibiotics.