101. Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis.
- Author
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Yasuda T, Ueda T, Takeyama Y, Shinzeki M, Sawa H, Nakajima T, Matsumoto I, Fujita T, Sakai T, Ajiki T, Fujino Y, and Kuroda Y
- Subjects
- Bacterial Infections epidemiology, Bacterial Infections etiology, Benzamidines, Biopsy, Fine-Needle, Drug Therapy, Combination, Female, Fibrinolysin antagonists & inhibitors, Follow-Up Studies, Guanidines administration & dosage, Humans, Imipenem administration & dosage, Incidence, Infusions, Intra-Arterial, Japan epidemiology, Male, Middle Aged, Pancreatitis, Acute Necrotizing complications, Pancreatitis, Acute Necrotizing diagnosis, Retrospective Studies, Severity of Illness Index, Survival Rate, Tomography, X-Ray Computed, Treatment Outcome, Anti-Bacterial Agents administration & dosage, Bacterial Infections prevention & control, Enteral Nutrition methods, Pancreatectomy methods, Pancreatitis, Acute Necrotizing therapy, Practice Guidelines as Topic, Protease Inhibitors administration & dosage
- Abstract
Background: In severe acute pancreatitis (SAP), infectious complications are the main contributors to high mortality. Since 1995, we have performed continuous regional arterial infusion of protease inhibitor and antibiotics (CRAI) and enteral nutrition (EN) as prevention therapies against infection. When infected pancreatic necrosis was proven, surgical intervention was adapted. The aim of this study was to investigate the clinical outcome of these treatments., Methods: We examined the relationship between the historical change of treatment strategy and clinical outcome. We divided 84 patients with acute necrotizing pancreatitis into two groups, CRAI (-) and CRAI (+), and compared the outcome. We divided 145 patients with SAP into two groups, EN (-) and EN (+), and compared the outcome. We also analyzed the outcome of surgical treatment., Results: In the CRAI (+) group, the incidence of infection, the frequency of surgery, and the mortality rate were lower than those in CRAI (-) group: 34% versus 51%, 27% versus 63% (P < 0.05), and 37% versus 54%, respectively. In the EN (+) group, the frequency of surgery and the mortality rate were lower than those in the EN (-) group: 23% versus 32% and 19% versus 35% (P < 0.05), respectively. These improvement effects were manifest in stage 3 (9 < or = Japanese Severity Score < or = 14). Treatment outcome of necrosectomy for infected pancreatic necrosis was still poor. Bleeding and abscess-gut fistula were postoperative life-threatening complications., Conclusions: CRAI and EN may improve the clinical outcome of SAP, reducing infection and averting pancreatic surgery.
- Published
- 2007
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