急性胰腺炎合并感染的抗生素应用

发布时间：2018-07-16 14:20

【摘要】：急性胰腺炎各阶段均可合并感染,感染发生与胰腺坏死及其程度有关。感染性胰腺坏死是胰腺继发感染的最常见类型,是影响急性重症胰腺炎预后的重要决定因素。抗感染药物是治疗的基本要素。虽然根据临床参数,急性胰腺炎患者继发感染的诊断困难,但影像学(气泡征)和影像学引导下细针穿刺是可靠的诊断手段。文中从急性胰腺炎合并感染的病理生理及诊断进行阐述,并对抗生素的合理应用进行介绍。抗生素预防性使用不能改善患者结局,确诊感染是抗生素唯一明确的适应证,应选择胰腺组织渗透性高且可覆盖院内腹腔感染常见病原体的抗生素方案。真菌感染应当被重视,并选择恰当的方法尽早诊断和治疗。当感染灶得到充分控制时,治疗疗程为7~10 d,但感染性坏死组织处理不理想时,需延长抗感染疗程。
[Abstract]:All stages of acute pancreatitis can be associated with infection, infection is related to pancreatic necrosis and its degree. Infectious pancreatic necrosis is the most common type of pancreatic secondary infection and an important determinant of prognosis of severe acute pancreatitis. Anti-infective drugs are essential for treatment. Although the diagnosis of secondary infection in patients with acute pancreatitis is difficult according to clinical parameters, imaging (bubble sign) and fine needle puncture guided by imaging are reliable diagnostic methods. In this paper, the pathophysiology and diagnosis of acute pancreatitis complicated with infection are described, and the rational application of antibiotics is introduced. Prophylactic use of antibiotics can not improve the outcome of the patients. The only definite indication of antibiotics is the diagnosis of infection. The antibiotic regimen with high permeability of pancreatic tissue and covering the common pathogens of nosocomial abdominal infection should be selected. Fungal infections should be valued and appropriate methods for early diagnosis and treatment should be chosen. When the infected foci were fully controlled, the course of treatment was 7 ~ 10 days, but when the treatment of infected necrotic tissue was not satisfactory, the course of anti-infection should be prolonged.
【作者单位】：广州总医院重症医学科;
【分类号】：R576

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