重症急性胰腺炎的诊断与治疗（英文教学）方案说明.pptVIP

Infection in acute pancreatitis;Duration 1 – 2 weeks 50% 3 weeks 71% Pancreatic abscess 4 weeks Parameters for diagnosing pancreatic necrosis 1. Ranson’s score 3 48 hours 2. Apache II illness grading system 10 3. C-reactive protein 120 mg/L 4. Lactate dehydrogenase 270 mg/L 5. Interleukin – 6 Poor accuracy in predicting severity;6. CECT – Gold standard 48 hours – high comparability overall accuracy – 95% 50 Hounsfield Unit – Nonperfused mortality morbidity No Necrosis 0% 6% Necrosis 23% 82% Air in pancreas/peripancreatic space – infection ;Pancreatic Infection;Antibiotic prophylaxis in severe acute pancreatitis;Unequal distribution of severity of pancreatitis Mortality significantly reduced with prophylactic antibiotics in high risk patients 10days – 4 weeks Ranson’s score ? 3 necrosis ? 30 two or more fluid collections Larger studies required to show a ? in mortality;Best choice - Imipenem – cilastatin quinolone + metrinidazole piperacillin - tazobactam Duration - 14 days or more Fluconazole after 7 days of antibiotics;American Society of gastroenterology Initiate antibiotics in severe acute pancreatitis (SAP) German Society of gastroenterology Start antibiotics in SAP CRP 120mg/L Ranson 3 APACHE II 8 multiorgan failure British Society of gastroenterology Prophylactic antibiotics early in SAP;Cost of antibiotics for 14-day therapy ;Selective decontamination of the digestive tract (SDD);Authors Animal Decontamination i inf- imor- Method Start ection tality Persky et al Dog Aureomycin 5-10d Not Yes before AEP studied Lange et al Rat Intestinal lavage Immediately Yes Yes + kanamycin before AEP Isaji et al Mouse Bacitracin+ M Simultaneously No Yes + neomycin with AEP Foitzik et al Rat Polymxin B+ 6h after AEP Yes No tobra +ampho Gianotti et al Mouse Various 36h after Yes No antibiotics beginning of CDE diet ;Randomized controlled clinical trial on SDD;Conclu