抗生素PPT课件（英文精品）Severe acute .pptVIP

Severe acute pancreatitis History 33-year-old male Alcohol binge: vodka Awake and conversant Severe abdominal pain, vomiting, dyspnoea Physical and laboratory examinations Temperature 38.1°C Pulse 96 bpm, respirations 20/min Blood pressure 110/70 mmHg Abdomen tender, distended, quiet Amylase 3500 IU/L Lipase 1100 IU/L AST 250 IU/L LDH 350 IU/L WBC count 16 000/mm3 Arterial blood gases: pH 7.30, PaCO2 32, PaO2 58, BE -5 Which evaluations would you perform to determine if the patient has severe pancreatitis? C-reactive protein Computed tomography (CT) scan Severity scores Ranson score Glasgow (Imrie) score APACHE II or III score Balthazar score Initial tests and treatment Fluid resuscitation Chest radiography CT Calculation of Ranson score (at 48 hours) The patient has severe pancreatitisby CT criteria Ranson score: a pancreatitis-specific severity of illness score Age 55 years WBC 16 000/mm3 Glucose 200 mg/dL LDH 350 IU/L AST 250 IU/L Haematocrit decrease 10% points BUN increase 5 mg/dL Serum calcium 8 mg/dL PaO2 60 mm Hg Base deficit -4 mEq/L Fluid sequestration 6 L The patient has eight positive Ranson criteria SGOT 250 IU/L LDH 350 IU/L WBC count 16 000/m?m3 PaO2 60 mm Hg Base deficit -4 mEq/L Net fluid sequestration 6 L Calcium concentration 8 mg/dL Haematocrit decrease 0 percentage points Would you start prophylactic antibiotics? No Yes, with … Ceftriaxone? Gentamicin plus metronidazole? Imipenem/cilastatin or meropenem? Ciprofloxacin plus metronidazole? Other? Yes, plus fluconazole Penetration of pancreatic tissue and pancreatic juice by antimicrobial agents Poor Aminoglycosides Vancomycin Variable Penicillins Cephalosporins Good Carbapenems Metronidazole Quinolones Fluconazole What is this patient’s risk of developing infection? 10% 10%–30% 30%–50% 50% Incidence of peripancreatic infection after acute pancreatitis All episodes 3%–7% Any pancreatic necrosis 20%–70% Pancreatic necrosis 30% 15%–30% Pancreatic necrosis 50%