中西医结合治疗重症急性胰腺炎不预防性使用抗生素的临床研究

目的：探讨中西医结合疗法对重症急性胰腺炎（severe acute pancreatitis，SAP）患者不预防性使用抗生素预后的影响。 方法：依据病例选择标准，纳入2005年1月～12月华西医院中西医结合科收治的SAP患者，按1：1随机分成试验组和对照组。两组采用相同方案的中西医结合治疗，另外，对照组预防性使用亚胺培南西司他丁钠0．5g，静脉滴注，每8小时1次，疗程为10d。观察入院48h Ranson和24h急性生理和慢性健康评价指标Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分，检测第1、3、7和第10天血清C反应蛋白含量，计算并发症的发生率，通过细菌或真菌培养观察感染的发生情况。 结果：试验组和对照组分别纳入26例和28例SAP患者。两组入院时的人口学及基线资料比较，差异均无统计学意义；两组并发症及感染发生率比较，差异亦无统计学意义。对照组培养出的真菌菌株数多于试验组（P〈0．05），两组G^-和G^＋菌株感染种类比较，差异无统计学意义。肺部、胰腺、血液、肠道和尿道均有发生感染。两组第1、3、7和第10天CRP含量比较，差异无统计学意义，但是感染病例第1、3、7和第10天CRP含量均高于非感染病例（P〈0．05，P〈0．01）。 结论：该研究不能证实在中西医结合治疗SAP过程中，预防性使用亚胺培南西司他丁钠可降低继发感染的发生率。

Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western medicine therapy: a randomized controlled trial

Objective： To investigate the prognostic effects of integrated traditional Chinese and Western medicine therapy without antibiotics in treatment of patients with severe acute pancreatitis （SAP）.
Methods： SAP patients were randomly divided into treatment group （26 cases included） and control group （28 cases included）. In addition to the same protocol of integrated traditional Chinese and Western medicine treatment for both groups, intravenous drip infusion of 0.5 g imipenem-cilastatin was administered to the patients in the control group every eight hours for ten days. The 48-hour Ranson score, 24-hour acute physiology and chronic heath evaluation Ⅱ score, and incidence rates of complications were observed. The concentrations of serum C-reactive protein （CRP） on days 1, 3, 7 and 10 were measured, and strains of infection were detected with smear and culture examination for bacteria and fungi.
Results： There were no statistical differences in demographic information, baseline data and incidence rates of complications between the two groups （P〉0.05）, but fungal infection rate in the control group was higher than that in the treatment group （P〈0.05）. There were no statistical differences in infection rates of G^- and G^＋ germs between the two groups; blood and some organs including lung, pancreas, intestine, and urethra were infected with bacteria and fungi. There were also no significant differences in the serum CRP concentrations on days 1, 3, 7 and 10 between the two groups （P 〉 0. 05）, but the serum CRP concentrations on days 1, 3, 7 and 10 in infected patients were higher than those in non-infected patients （P〈0.05, P〈0. 01）. Conclusion： The study cannot confirm that the incidence rates of secondary infection and mortality in SAP patients treated with integrated traditional Chinese and Western medicine are reduced by prophylaxis with imipenem-cilastatin.