摘要
总结了经手术证实为急性出血坏死性胰腺炎的５３例患者的手术疗效。发现该病应早期手术。若发病４天后手术，体温在３８℃以上、脉搏超过１２０次／分、收缩压在１２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）以下、有弥漫性腹膜炎、白细胞高于１６×１０９／Ｌ和术后有重要器官功能衰竭者，术后病死率明显增高。手术方法以胰腺坏死组织清除加三造瘘、腹腔三套管持续冲洗为优。抑制胰腺分泌的药物主要选用５氟脲嘧啶。引起胰腺感染的常见病原菌依次是大肠杆菌、肺炎克雷白杆菌、肠球菌、金黄色葡萄球菌、绿脓杆菌、奇异假单胞菌、链球菌、产气肠杆菌和脆弱类杆菌９种细菌。选用抗生素应遵守３个原则：①抗生素必须能通过血胰屏障。②能在胰腺组织中形成有效的治疗浓度。③能有效地抑制引起胰腺感染的病原菌。这样，才能取得良好的治疗效果。
We summarized the effect of surgical treatment for 53 patients who were proved to suffer from acute hemorrhagic necrotic pancreatitis (AHNP)by means of surgical operation,from which we found that the patients with AHNP ought to be operated on at the inital stage of the desease.The postoperative death rate was evidently increased under one of the following conditions:the operation was performed four days after the attack of the desease;the body temperature was above 38℃;the pulse rate was more than 120 per minute;the systolic blood pressure was below 12 kPa;there was general peritonitis;lenkocytes were more than 16×10 9/L;the major organs were dysfunctioned after operation.The preferable surgical procedures include the clearance of necrotic tissues of the pancreas,fistulization of the stomach,the gallbladder and the vacant intestine and continuous irrigation of the abdominal cavity with threeoverlapping tube.The main medicine used to inhibit pancreatic secretion is 5fluorouracil.The nine common pathogens causing pancreas infection are Bacillus coli,Klebsiella pneumoniae.Enterococcus,staphylococcus aureus,Pseudomonas aeruginosa,Proteus mirabilis,Streptococcus.Enterobacter aerogenes and Bacteroides fragilis,in their given order.In order to obtain a satisfactory therapeutic effectiveness,antibiotics are selected in accordance with the three principles:1)the antibiotics should be able to go through the blood pancreas barrier;2)effective concentration of the antibiotics in the pancreas should be reached;3)the antibiotics can effectively inhibit the pathogens causing pancreatic infection.
出处
《中国危重病急救医学》
CAS
CSCD
1996年第2期82-84,共3页
Chinese Critical Care Medicine
关键词
胰腺炎
出血性
坏死性
治疗
外科手术
acute hemorrhagic necrotic panereatitis
surgical treatmont
