| Acute pancreatitis is an acute inflammation of pancreas, and most patients are of mild pancreatitis, with good prognosis, while minority of severe acute pancreatitis (SAP), usually with systemic or local complication, in an extremely dangerous state, and the fatality rate among them is high. At present, there is still no data on large sample epidemiological investigation for acute pancreatitis, and therefore the basic features on incidence and cause of disease, etc. are not so clear. Further more, in clinical literatures for medication of acute pancreatitis, there is lack of evidence-based study, but more experience summarization, which negatively influenced further improvement of treatment level.This study was performed to explore the basic features of cases of acute pancreatitis, and the effect of antibacterial drugs on acute pancreatitis based on descriptive analysis and Meta analysis, etc. Part one: Descriptive analysis on 6,223 APTotal hospitalized 6223 cases diagnosed as acute pancreatitis from 15 comprehensive hospitals all over the country between September 1995 and September 2005 were surveyed, and the basic features of acute pancreatitis and the situation of medication were analyzed through investigation on background of cases and relevant medication. Cost of drugs were adopted for analyzing the reasonableness of application of antibacterial drugs on acute pancreatitis.Among all the cases, 107 (1.7%) were rejected from the statistical analysis for incomplete data. Therefore, total 6,223 cases of acute pancreatitis were finally accepted for this study.Age and sex of cases: The average age for the 6223 cases of acute pancreatitis was 51.2±17.3 years (2-99 years) old, and there were 3,237 (52.0%) male cases, and 2,986 (48.0%) female cases. There were 1,743 (28.0%) cases of severe acute pancreatitis, and 72.0% (4,480/6,223) were of mild acute pancreatitis.Cause of disease: Disease of biliary tract (3,385/6,223) was the first main cause of this group of cases, while idiopathic pancreatitis was only inferior to the disease ofbiliary tract, with cases of 19.7%, and pancreatitis with hyperlipemia was the third, with cases of 12.6% (782/6,223).Death rate: The general death rate of this group was 4.6% (284/6,223), while the death rate for severe idiopathic pancreatitis (29.5%) was the highest.Medication: In application of antibacterial drugs, and drugs for pamcreatin inhibition and gastric acid inhibition for severe acute pancreatitis, Metronidazole, Sandostatin and Omeprazole were used the most frequently, and 51.4% of the patients were administered antibiotics. The frequency for use of drugs was in sequence. In application of antibacterial drugs, and drugs for pamcreatin inhibition and gastric acid inhibition for mild acute pancreatitis, Metronidazole, Sandostatin and Omeprazole were also used the most frequently, and 39.2% of the patients were also administered antibacterial drugs, and the frequency sequence for type of drugs was the same as that of severe patients.In the four centers with available cases of severe acute pancreatitis more than 10%, the cost for antibacterial drugs was approximately 22.64—31.25% of the total for hospitalization, and Metronidazole, Kfioxacin, Cefoperazone / Sulbactam, Ciprofloxacin, and imipenem were the five drugs used the most frequently by the centers, which were significantly different for sequence of administered case-times and average days for use. The DUI for the five was approximately 1, which showed that the use of antibacterial drugs was basically reasonable. Part two: Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis, a meta analysis.Search for randomized clinical test (RCT) on preventive medication of antibacterial drugs on severe acute pancreatitis published from 1966 to October 2005. According to standard of selection, relevant test design, characteristics of patients, and test results, etc. from selected studies were extracted, and RevMan4.2 database was used for Meta analysis and discuss on influence of preventive medication of antibacterial drugs on death rate, pancreas infection, surgical intervention and exopathic pancreas infection.There were 6 RCTs accepted, and total 187 cases selected for the test group,while 186 cases for the control group.Death rate: In the test group, 13 cases died, while in the control group, 27 cases died, with dominance ratio of 0.453, and the confidence interval of 95% was 0.226—0.904.Pancreas infection: In the test group, 35 cases were infected, while in the control group, 47 cases were infected, with dominance ratio of 0.645, and the confidence interval of 95% was 0.382—1.086.Surgical intervention: In the test group, 35 cases were performed operation, while in the control group, 41 cases were performed operation, with dominance ratio of 0.765, and the confidence interval of 95% was 0.454—1.289.Infection rate: In the test group, 37 cases were of exopathic pancreas infection, while in the control group, 61 cases were of exopathic pancreas infection, with dominance ratio of 0.469, and the confidence interval of 95% was 0.145—1.521. Part three: Effect of antibiotic therapy on prognosis the of SAP.Total 208 cases of severe acute pancreatitis treated in our hospital between September 2000 and September 2005 were analyzed. According to different conditions for use of antibacterial drugs, the time (d) for use of antibacterial drugs after admission was calculated based on the use of antibacterial drug used the first. If the time was 1 d or less, it was counted in Prevention group (PA), and if more than 1 day, counted in Non-prevention group. The differences on outcome of disease, days of hospitalization, and hospitalization cost, etc. between the two groups were compared with the group that used no antibacterial drugs (NA) as the control, for explaining the effect of preventive use of antibacterial drugs in SAP treatment. There were 55 cases, 36 cases and 117 cases for NA, NPA, and PA respectively.For NA, the APACHE II grade was 0.5 for the condition of pancreatitis was mild relatively, and the time for hospitalization was significant shorter than PA and NPA, in which antibacterial drugs were used. The average time for hospitalization for PA was 15.7±0.9d, which was significantly less than that for NPA, 26.2±2.9d ( p<0.001 fort test).In PA and NPA, 2 cases and 1 cases died respectively, and there was nosignificant difference of death rate between the two (1.7% vs 2.8%, p=0.55 for x 2 test) .In PA and NPA, 25.0% (9/36) and 6.0% (7/117) were found one or more types of complication respectively, and x 2 test showed that and there was a significant statistical difference between the two (p=0.001)The average time for body temperature to normal level was 13.3±3.0 days in NPA, while only 4.6 + 0.5 days in PA. The time for serum amylase to normal level was 5.3 ±0.5 days in PA, whilelO.4± 1.6 days in NPA.The mycotic infection rate in PA was 8.5%, which was significantly lower than that in NPA, 27.8 % (p=0.003 for x 2 test).According to above results, we concluded as follows:In our country, the incidence of AP was mostly among people aged 31 to 70 years, while the peak incidence was among those aged 41 to 50 years. The first main cause was disease of biliary tract (54.4%), with general death rate of 4.6% (284/6,223), and death rate of severe idiopathic pancreatitis (29.5%) the highest. The trend of drug administer for medication for mild acute pancreatitis patients was similar to that for severe patients. The use of antibacterial drugs is basically reasonable for severe acute pancreatitis patients, while for mild acute pancreatitis patients, and there may be unreasonable conditions for use of antibacterial drugs.Meta analysis showed that there was no superiority for preventive medication of antibacterial drugs on pancreas infection, surgical intervention and exopathic pancreas infection, while valuable to some extent for death rate.Analysis on cases in our hospital showed that use of antibacterial drugs on the day of admission may significantly shorten the days of hospitalization of SAP patients, and reduce incidence of complication, and also may resume body temperature, hemodiastase and leukocyte count of the patients to normal level in advance, which was valuable for improving prognosis of such patients.
|
PDF Full Text Request