(精选)重症急性胰腺炎的诊断与治疗(英文课件)教学课件.pptVIP

Infection in acute pancreatitis Acute pancreatitis: Interstitial: 80% Necrotizing: 20% Infection dependent on - necrosis Extent of necrosis Sterile (n = 155) Infected ( n = 71) 30% (mild) 57 % 35 % 30 - 50% (mod) 22 % 23 % 50% (severe) 21 % 42 % 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 * unresolved organ failure * persisting systemic toxicity – high fever, ? TLC * low grade fever, 15000 cells US/CT guided FNA necrosis + fluid collection 20 – 22G needle Gram stain + culture Avoid colon - oral contrast agent Influence of pancreatic infection on morbidity and mortality Morbidity Sterile necrosis Infected necrosis Pulmonary 56% 72% Renal 28% 45% Cardiocirculatory 13% 30% Mortality 11% 20% Bacteriologic findings of infected pancreatitis E coli (35%) Enterococcus (24%) Klebsiella pneumoniae (24%) Pseudomonas (11%) Proteus (8%) Aerobic streptococcus (7%) Enterobacter (7%) Bacteroides (6%) Anaerobes (6%) Fungal – antibiotics for long Monomicrobial 58% Polymicrobial 42% Possible pathways for pancreatic infection Colon – bacterial translocation Lymphatics, Hematogenous, Transmural Antibiotics in pancreatitis Drug concentration pancreas/peripancreatic tissue Efficacy Factor Aminoglycosides Netilmycin 0.14 Tobramycin 0.12 Ureidopenicillins Mezlocillin 0.71 Piperacillin 0.72 Cephalosporins Ceftrizoxime 0.76 Cefotaxime 0.78 Ceftriaxone 0.