• 遵義醫(yī)學(xué)院附屬醫(yī)院肝膽胰外科（貴州遵義 563003）;

目的 　探討重癥急性胰腺炎（severe acute pancreatitis，SAP）并發(fā)感染的早期預(yù)防措施。
方法 　復(fù)習(xí)國內(nèi)外近10年來關(guān)于SAP并發(fā)感染方面的文獻，討論早期采取措施對SAP并發(fā)感染的影響。
結(jié)果 　早期應(yīng)用易透過血-胰屏障的抗生素，合理使用質(zhì)子泵抑制劑，盡早給予腸內(nèi)營養(yǎng)、血液濾過、高壓氧等治療，再配合中醫(yī)治療，可以減少SAP時感染的發(fā)生，提高其治愈率。
結(jié)論 　SAP并發(fā)感染是后期患者死亡的主要原因之一，在SAP早期采取綜合有效的治療措施，可降低感染率；但仍有些問題尚不清楚，需進一步探索。

引用本文： 魏巍,兌丹華. 重癥急性胰腺炎并發(fā)感染的早期預(yù)防. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(6): 697-703. doi: 復(fù)制

1. Bhatia M， Brady M， Shokuhi S， et al. Inflammatory mediators in acute pancreatitis[J]. J Pathol， 2000， 190(2)：117-125.
2. Bhatia M， Neoptolemos JP， Slavin J. Inflammatory mediators as therapeutic targets in acute pancreatitis[J]. Curr Opin Investig Drugs， 2001， 2(4)：496-501.
3. Blagovestnov DA， Khvatov VB， Upyrev AV， et al. Combined treatment of acute pancreatitis and its complications[J]. Khirurgiia(Mosk)， 2004， (5)：68-75.
4. Hall A， Poole L， Renton B， et al. Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis[J]. Crit Care， 2013， 17(2)：R49. [Epub ahead of print] .
5. Wang SQ， Feng QX， Li SJ， et al. The day when infection is confirmed is a better time point for mortality prediction in patients with severe acute pancreatitis[J]. Pancreas， 2012， 41(4)：605-610.
6. Tsui NC， Zhao E， Li Z， et al. Microbiological findings in secondaryinfection of severe acute pancreatitis：a retrospective clinical study[J]. Pancreas， 2009， 38(5)：499-502.
7. Wu BU， Johannes RS， Kurtz S， et al. The impact of hospital-acquired infection on outcome in acute pancreatitis [J]. Gastroenterology， 2008， 135(3)：816-820.
8. Su MS， Lin MH， Zhao QH， et al. Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancr-eatitis[J]. Chin Med J (Engl)， 2012， 125(10)：1772-1776.
9. Wittau M， Mayer B， Scheele J， et al. Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis[J]. Scand J Gastroenterol， 2011， 46(3)：261-270.
10. Ignatavicius P， Vitkauskiene A， Pundzius J， et al. Effects of prophylactic antibiotics in acute pancreatitis[J]. HPB (Oxford)， 2012， 14(6)：396-402.
11. Jafri NS， Mahid SS， Idstein SR， et al. Antibiotic prophylaxis is not protective in severe acute pancreatitis：a systematic review and meta-analysis[J]. Am J Surg， 2009， 197(6)：806-813.
12. Yao L， Huang X， Li Y， et al. Prophylactic antibiotics reduce pancreatic necrosis in acute necrotizing pancreatitis：a meta-analysis of randomized trials[J]. Dig Surg， 2010， 27(6)：442-449.
13. Jiang K， Huang W， Yang XN， et al. Present and future of prophy-lactic antibiotics for severe acute pancreatitis[J]. World J Gastro-enterol， 2012， 18(3)：279-284.
14. (46)：6203-6207.
15. 中華醫(yī)學(xué)會消化病學(xué)分會胰腺疾病學(xué)組. 中國急性胰腺炎診治指南(草案)[J]. 中華消化雜志， 2004， 24(3)：190-192.
16. 夏慶， 黃偉， 楊曉楠. 重癥急性胰腺炎預(yù)防性使用抗生素的認識和評價[J]. 世界華人消化雜志， 2008， 16(3)：1446-1451.
17. Beger HG， Gansauge F， Poch B， et al. The use of antibiotics for acute pancreatitis：is there a role?[J]. Curr Infect Dis Rep， 2009， 11(2)：101-107.
18. Bassi C， Larvin M， Villatoro E. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis[J]. Cochrane Database Syst Rev， 2003， (4)：CD002941.
19. 中國中西醫(yī)結(jié)合學(xué)會普通外科專業(yè)委員會. 重癥急性胰腺炎中西醫(yī)結(jié)合診治常規(guī)(草案)[J]. 中國危重病急救醫(yī)學(xué)， 2007， 19(8)：448-451.
20. Wu XM， Ji KQ， Wang HY， et al. Total enteral nutrition in preve-ntion of pancreatic necrotic infection in severe acute pancreatitis[J]. Pancreas， 2010， 39(2)：248-251.
21. Vieira JP， Araújo GF， Azevedo JR， et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis[J]. Acta Cir Bras， 2010， 25(5)：449-454.
22. Al-Omran M， Albalawi ZH， Tashkandi MF， et al. Enteral versus parenteral nutrition for acute pancreatitis[J]. Cochrane Database Syst Rev， 2010， (1)：CD002837.
23. Yi F， Ge L， Zhao J， et al. Meta-analysis：total parenteral nutrition versus total enteral nutrition in predicted severe acute pancr-eatitis[J]. Intern Med， 2012， 51(6)：523-530.
24. Makola D， Krenitsky J， Parrish C， et al. Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula[J]. Am J Gastroenterol， 2006， 101(10)：2347-2355.
25. Louie BE， Noseworthy T， Hailey D， et al. 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis：a randomized controlled trial and health technology assessment[J]. Can J Surg， 2005， 48(4)：298-306.
26. Bakker OJ， van Santvoort HC， van Brunschot S， et al. Pancreatitis，very early compared with normal start of enteral feeding (PYTHONtrial)：design and rationale of a randomised controlled multicenter trial[J]. Trials， 2011， 12：73.
27. Petrov MS， Pylypchuk RD， Uchugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis[J]. Br J Nutr， 2009， 101(6)：787-793.
28. Marik PE. What is the best way to feed patients with pancreatitis?[J]. Curr Opin Crit Care， 2009， 15(2)：131-138.
29. Xue P， Deng LH， Xia Q， et al. Impact of alanyl-glutaminedipeptide on severe acute pancreatitis in early stage[J]. World J Gastroenterol， 2008， 14(3)：474-478.
30. Zou XP， Chen M， Wei W， et al. Effects of enteral immunonutritionon the maintenance of gut barrier function and immune function in pigs with severe acute pancreatitis[J]. JPEN J Parenter Enteral Nutr， 2010， 34(5)：554-566.
31. Wang X， Li W， Zhang F， et al. Fish oil-supplemented parenteralnutrition in severe acute pancreatitis patients and effects on immunefunction and infectious risk：a randomized controlled trial[J]. Inflammation， 2009， 32(5)：304-309.
32. Petrov MS， Atduev VA， Zagainov VE. Advanced enteral therapy in acute pancreatitis：is there a room for immunonutrition? A meta-analysis[J]. Int J Surg， 2008， 6(2)：119-124.
33. Lutgendorff F， Trulsson LM， van Minnen LP， et al. Probiotics enhance pancreatic glutathione biosynthesis and reduce oxidative stress in experimental acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol， 2008， 295(5)：G1111- G1121.
34. Lutgendorff F， Nijmeijer RM， Sandstrom PA， et al. Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J]. PloS One， 2009， 4(2)：e4512.
35. Rychter JW， van Minnen LP， Verheem A， et al. Pretreatment but not treatment with probiotics abolishes mouse intestinal barrier dysfunction in acute pancreatitis[J]. Surgery， 2009， 145(2)：157-167.
36. Plaudis H， Pupelis G， Zeiza K， et al. Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with severe acute pancreatitis：a prospective feasibility study[J]. Acta Chir Belg， 2012， 112(2)：131-138.
37. Sharma B， Srivastava S， Singh N， et al. Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis：a double-blind randomized controlled trial[J]. J Clin Gastroenterol， 2011， 45(5)：442-448.
38. Besselink MG， van Santvoort HC， Buskens E， et al. Probiotic prophylaxis in predicted severe acute pancreatitis：a randomised， double-blind， placebo-controlled trial[J]. Lancet， 2008， 371(9613)：651-659.
39. Verma R， Dhamija R， Ross SC， et al. Symbiotic bacteria inducednecrotizing pancreatitis[J]. JOP， 2010， 11(5)：474-476.
40. Sun S， Yang K， He X， et al. Probiotics in patients with severe acute pancreatitis：a meta-analysis[J]. Langenbecks Arch Surg， 2009， 394(1)：171-177.
41. Zhang MM， Cheng JQ， Lu YR， et al. Use of pre-， pro- and synb-iotics in patients with acute pancreatitis：a meta-analysis[J]. World J Gastroenterol， 2010， 16(31)：3970-3978.
42. Petrov MS， Loveday BP， Pylypchuk RD， et al. Systematic reviewand meta-analysis of enteral nutrition formulations in acute pancr-eatitis[J]. Br J Surg， 2009， 96(11)：1243-1252.
43. Zhang XP， Jiang J， Yu YP， et al. Effect of Danshen on apoptosis and NF-kappaB protein expression of the intestinal mucosa of rats with severe acute pancreatitis or obstructive jaundice[J]. Hepatobiliary Pancreat Dis Int， 2010， 9(5)：537-546.
44. Zhang Z， Wang Y， Dong M， et al. Oxymatrine amelioratesL-arginine-induced acute pancreatitis in rats[J]. Inflammation， 2012， 35(2)：605-613.
45. Wang G， Sun B， Zhu H， et al. Protective effects of emodin combined with danshensu on experimental severe acute pancreatitis[J]. Inflamm Res， 2010， 59(6)：479-488.
46. Zhang XP， Wang C， Wu DJ， et al. Protective effects of ligustrazine，kakonein and Panax notoginsenosides on multiple organs in rats with severe acute pancreatitis[J]. Methods Find Exp Clin Pharmacol， 2011， 32(9)：631-644.
47. Jha RK， Ma Q， Lei Z， et al. Resveratrol ameliorates the delete-rious effect of severe acute pancreatitis[J]. Cell Biochem Biophys，.
48. Chen H， Li F， Jia JG， et al. Effects of traditional Chinese medicineon intestinal mucosal permeability in early phase of severe acute pancreatitis[J]. Chin Med J (Engl)， 2010， 123(12)：1537-1542.
49. 羅艷紅， 鐘廣偉， 趙雙平， 等. 應(yīng)用電針干預(yù)重癥早期急性胰腺炎并發(fā)腸麻痹[J]. 中國針灸， 2011， 31(2)：105-109.
50. 李杰， 李賀， 孫備， 等. 大黃聯(lián)合電針促進重癥急性胰腺炎胃腸道功能復(fù)蘇的臨床研究[J]. 中國中西醫(yī)結(jié)合雜志， 2009， 29(7)：661-662.
51. 薛奇明， 李寧， 薛平， 等. 電針“足三里”對急性胰腺炎大鼠血清促炎因子及胰腺核因子-kB活性的影響[J]. 針刺研究， 2011， 36(4)：272-277.
52. 薛奇明， 黃露， 李寧. 電針天樞穴對重癥急性胰腺炎大鼠血清促炎和抗炎因子的影響[J]. 中西醫(yī)結(jié)合學(xué)報， 2011， 9(6)：658-664.
53. 王新宇. 電針治療急性胰腺炎及對患者腸道通透性的影響[J]. 中國針灸， 2007， 27(6)：421-423.
54. An HJ， Lee JH， Lee HJ， et al. Electroacupuncture protects against CCK-induced acute pancreatitis in rats[J]. Neuroimmunomodulation， 2007， 14(2)：112-118.
55. Uhm MS， Kim YS， Suh SC， et al. Acute pancreatitis induced by traditional acupuncture therapy[J]. Eur J Gastroenterol Hepatol，.
56. 劉續(xù)寶， 蔣俊明， 黃宗文， 等. 中西醫(yī)結(jié)合治療重癥急性胰腺炎的臨床研究(附1 376例報告)[J]. 四川大學(xué)學(xué)報：醫(yī)學(xué)版， 2004， 35(2)：204-208.
57. Caronna R， Benedetti M， Morelli A， et al. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis[J]. World J Emerg Surg， 2009， 4：45.
58. Souza LJ， Coelho AM， Sampietre SN， et al. Anti-inflammatory effects of peritoneal lavage in acute pancreatitis[J]. Pancreas， 2010， 39(8)：1180-1184.
59. Meng K， Liu Q， Dou Y， et al. Prior peritoneal lavage with hot 0.9% saline induces HSP70 expression and protects against cerule-ininduced acute pancreatitis in rats[J]. Mol Biol Rep， 2013， 40(2)：1443-1449.
60. Dong Z， Petrov MS， Xu J， et al. Peritoneal lavage for severe acute pancreatitis：a systematic review of randomised trials[J]. World J Surg， 2010， 34(9)：2103-2108.
61. Zhu Y， Yuan J， Zhang P， et al. Adjunctive continuous high-volume hemofiltration in patients with acute severe pancreatitis：a prospective nonrandomized study[J]. Pancreas， 2011， 40(1)：109-113.
62. He C， Zhang L， Shi W， et al. Coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration treatment in patients with severe acute pancreatitis[J]. 2013， 47(1)：62-68.
63. Tao J， Gong D， Ji D， et al. Improvement of monocyte secretionfunction in a porcine pancreatitis model by continuous dose depen-dent veno-venous hemofiltration[J]. Int J Artif Organs， 2008， 31(8)：716-721.
64. Zhang J， Yuan C， Hua G， et al. Early gut barrier dysfunction in patients with severe acute pancreatitis：attenuated by continuousblood purification treatment[J]. Int J Artif Organs， 2010， 33(10)：706-715.
65. Pupelis G， Plaudis H， Zeiza K， et al. Early continuous veno-venous haemofiltration in the management of severe acute pancr-eatitis complicated with intra-abdominal hypertension：retrospectivereview of 10 years’ experience[J]. Ann Intensive Care， 2012， 2(Suppl 1)：S21.
66. Hirasawa H. Indications for blood purification in critical care[J]. Contrib Nephrol， 2010， 166：21-30.
67. Bai X， Sun B， Pan S， et al. Down-regulation of hypoxia-induciblefactor-1alpha by hyperbaric oxygen attenuates the severity of acute pancreatitis in rats[J]. Pancreas， 2009， 38(5)：515-522.
68. Uysal B， Yasar M， Ersoz N， et al. Efficacy of hyperbaric oxygen therapy and medical ozone therapy in experimental acute necrotizingpancreatitis[J]. Pancreas， 2010， 39(1)：9-15.
69. Hou J， Zhu MW， He XW， et al. Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin， soluble CD14， endotoxin-neutralizing capacity and cytokines in acute necrotizing pancreatitis[J]. Can J Surg， 2010， 53(4)：241-245.
70. Yu X， Li YG， He XW， et al. Hyperbaric oxygen reduces inflammatory response in acute pancreatitis by inhibiting NF-kappaB activation[J]. Eur Surg Res， 2009， 42(2)：130-135.
71. Cuthbertson CM， Su KH， Muralidharan V， et al. Hyperbaric oxygen improves capillary morphology in severe acute pancreatitis[J]. Pancreas， 2008， 36(1)：70-75.
72. Koh SL， Tan JW， Muralidharan V， et al. The effect of hyperbaric oxygen on apoptosis and proliferation in severe acute pancreatitis[J]. HPB (Oxford)， 2009， 11(8)：629-637.
73. Comert B， Isik AT， Aydin S， et al. Combination of allopurinol and hyperbaric oxygen therapy：a new treatment in experimentalacute necrotizing pancreatitis?[J]. World J Gastroenterol， 2007，.
74. Mas N， Isik AT， Mas MR， et al. Hyperbaric oxygen-induced changes in bacterial translocation and acinar ultrastructure in rat acute necrotizing pancreatitis[J]. J Gastroenterol， 2005， 40(10)：980-986.
75. Cuthbertson CM， Christophi C. Potential effects of hyperbaric oxygen therapy in acute pancreatitis[J]. ANZ J Surg， 2006， 76(7)：625-630.
76. Deshpande A， Pant C， Pasupuleti V， et al. Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis[J]. Clin Gastroenterol Hepatol， 2012， 10(3)：225-233.
77. Dalton BR， Lye-Maccannell T， Henderson EA， et al. Proton pump inhibitors increase significantly the risk of Clostridium difficileinfection in a low-endemicity， non-outbreak hospital setting[J]. Aliment Pharmacol Ther， 2009， 29(6)：626-634.
78. Lo WK， Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth：a meta-analysis[J]. Clin Gastroenterol Hepatol， 2013， 11(5)：483-490.
79. Ratuapli SK， Ellington TG， O’Neill MT， et al. Proton pump inhi-bitor therapy use does not predispose to small intestinal bacterial overgrowth[J]. Am J Gastroenterol， 2012， 107(5)：730-735.
80. ， 17(6)：675-677.
81. ， 62(2)：397-402.
  1. 1. Bhatia M， Brady M， Shokuhi S， et al. Inflammatory mediators in acute pancreatitis[J]. J Pathol， 2000， 190(2)：117-125.
  2. 2. Bhatia M， Neoptolemos JP， Slavin J. Inflammatory mediators as therapeutic targets in acute pancreatitis[J]. Curr Opin Investig Drugs， 2001， 2(4)：496-501.
  3. 3. Blagovestnov DA， Khvatov VB， Upyrev AV， et al. Combined treatment of acute pancreatitis and its complications[J]. Khirurgiia(Mosk)， 2004， (5)：68-75.
  4. 4. Hall A， Poole L， Renton B， et al. Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis[J]. Crit Care， 2013， 17(2)：R49. [Epub ahead of print] .
  5. 5. Wang SQ， Feng QX， Li SJ， et al. The day when infection is confirmed is a better time point for mortality prediction in patients with severe acute pancreatitis[J]. Pancreas， 2012， 41(4)：605-610.
  6. 6. Tsui NC， Zhao E， Li Z， et al. Microbiological findings in secondaryinfection of severe acute pancreatitis：a retrospective clinical study[J]. Pancreas， 2009， 38(5)：499-502.
  7. 7. Wu BU， Johannes RS， Kurtz S， et al. The impact of hospital-acquired infection on outcome in acute pancreatitis [J]. Gastroenterology， 2008， 135(3)：816-820.
  8. 8. Su MS， Lin MH， Zhao QH， et al. Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancr-eatitis[J]. Chin Med J (Engl)， 2012， 125(10)：1772-1776.
  9. 9. Wittau M， Mayer B， Scheele J， et al. Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis[J]. Scand J Gastroenterol， 2011， 46(3)：261-270.
  10. 10. Ignatavicius P， Vitkauskiene A， Pundzius J， et al. Effects of prophylactic antibiotics in acute pancreatitis[J]. HPB (Oxford)， 2012， 14(6)：396-402.
  11. 11. Jafri NS， Mahid SS， Idstein SR， et al. Antibiotic prophylaxis is not protective in severe acute pancreatitis：a systematic review and meta-analysis[J]. Am J Surg， 2009， 197(6)：806-813.
  12. 12. Yao L， Huang X， Li Y， et al. Prophylactic antibiotics reduce pancreatic necrosis in acute necrotizing pancreatitis：a meta-analysis of randomized trials[J]. Dig Surg， 2010， 27(6)：442-449.
  13. 13. Jiang K， Huang W， Yang XN， et al. Present and future of prophy-lactic antibiotics for severe acute pancreatitis[J]. World J Gastro-enterol， 2012， 18(3)：279-284.
  14. 14. (46)：6203-6207.
  15. 15. 中華醫(yī)學(xué)會消化病學(xué)分會胰腺疾病學(xué)組. 中國急性胰腺炎診治指南(草案)[J]. 中華消化雜志， 2004， 24(3)：190-192.
  16. 16. 夏慶， 黃偉， 楊曉楠. 重癥急性胰腺炎預(yù)防性使用抗生素的認識和評價[J]. 世界華人消化雜志， 2008， 16(3)：1446-1451.
  17. 17. Beger HG， Gansauge F， Poch B， et al. The use of antibiotics for acute pancreatitis：is there a role?[J]. Curr Infect Dis Rep， 2009， 11(2)：101-107.
  18. 18. Bassi C， Larvin M， Villatoro E. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis[J]. Cochrane Database Syst Rev， 2003， (4)：CD002941.
  19. 19. 中國中西醫(yī)結(jié)合學(xué)會普通外科專業(yè)委員會. 重癥急性胰腺炎中西醫(yī)結(jié)合診治常規(guī)(草案)[J]. 中國危重病急救醫(yī)學(xué)， 2007， 19(8)：448-451.
  20. 20. Wu XM， Ji KQ， Wang HY， et al. Total enteral nutrition in preve-ntion of pancreatic necrotic infection in severe acute pancreatitis[J]. Pancreas， 2010， 39(2)：248-251.
  21. 21. Vieira JP， Araújo GF， Azevedo JR， et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis[J]. Acta Cir Bras， 2010， 25(5)：449-454.
  22. 22. Al-Omran M， Albalawi ZH， Tashkandi MF， et al. Enteral versus parenteral nutrition for acute pancreatitis[J]. Cochrane Database Syst Rev， 2010， (1)：CD002837.
  23. 23. Yi F， Ge L， Zhao J， et al. Meta-analysis：total parenteral nutrition versus total enteral nutrition in predicted severe acute pancr-eatitis[J]. Intern Med， 2012， 51(6)：523-530.
  24. 24. Makola D， Krenitsky J， Parrish C， et al. Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula[J]. Am J Gastroenterol， 2006， 101(10)：2347-2355.
  25. 25. Louie BE， Noseworthy T， Hailey D， et al. 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis：a randomized controlled trial and health technology assessment[J]. Can J Surg， 2005， 48(4)：298-306.
  26. 26. Bakker OJ， van Santvoort HC， van Brunschot S， et al. Pancreatitis，very early compared with normal start of enteral feeding (PYTHONtrial)：design and rationale of a randomised controlled multicenter trial[J]. Trials， 2011， 12：73.
  27. 27. Petrov MS， Pylypchuk RD， Uchugina AF. A systematic review on the timing of artificial nutrition in acute pancreatitis[J]. Br J Nutr， 2009， 101(6)：787-793.
  28. 28. Marik PE. What is the best way to feed patients with pancreatitis?[J]. Curr Opin Crit Care， 2009， 15(2)：131-138.
  29. 29. Xue P， Deng LH， Xia Q， et al. Impact of alanyl-glutaminedipeptide on severe acute pancreatitis in early stage[J]. World J Gastroenterol， 2008， 14(3)：474-478.
  30. 30. Zou XP， Chen M， Wei W， et al. Effects of enteral immunonutritionon the maintenance of gut barrier function and immune function in pigs with severe acute pancreatitis[J]. JPEN J Parenter Enteral Nutr， 2010， 34(5)：554-566.
  31. 31. Wang X， Li W， Zhang F， et al. Fish oil-supplemented parenteralnutrition in severe acute pancreatitis patients and effects on immunefunction and infectious risk：a randomized controlled trial[J]. Inflammation， 2009， 32(5)：304-309.
  32. 32. Petrov MS， Atduev VA， Zagainov VE. Advanced enteral therapy in acute pancreatitis：is there a room for immunonutrition? A meta-analysis[J]. Int J Surg， 2008， 6(2)：119-124.
  33. 33. Lutgendorff F， Trulsson LM， van Minnen LP， et al. Probiotics enhance pancreatic glutathione biosynthesis and reduce oxidative stress in experimental acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol， 2008， 295(5)：G1111- G1121.
  34. 34. Lutgendorff F， Nijmeijer RM， Sandstrom PA， et al. Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J]. PloS One， 2009， 4(2)：e4512.
  35. 35. Rychter JW， van Minnen LP， Verheem A， et al. Pretreatment but not treatment with probiotics abolishes mouse intestinal barrier dysfunction in acute pancreatitis[J]. Surgery， 2009， 145(2)：157-167.
  36. 36. Plaudis H， Pupelis G， Zeiza K， et al. Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with severe acute pancreatitis：a prospective feasibility study[J]. Acta Chir Belg， 2012， 112(2)：131-138.
  37. 37. Sharma B， Srivastava S， Singh N， et al. Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis：a double-blind randomized controlled trial[J]. J Clin Gastroenterol， 2011， 45(5)：442-448.
  38. 38. Besselink MG， van Santvoort HC， Buskens E， et al. Probiotic prophylaxis in predicted severe acute pancreatitis：a randomised， double-blind， placebo-controlled trial[J]. Lancet， 2008， 371(9613)：651-659.
  39. 39. Verma R， Dhamija R， Ross SC， et al. Symbiotic bacteria inducednecrotizing pancreatitis[J]. JOP， 2010， 11(5)：474-476.
  40. 40. Sun S， Yang K， He X， et al. Probiotics in patients with severe acute pancreatitis：a meta-analysis[J]. Langenbecks Arch Surg， 2009， 394(1)：171-177.
  41. 41. Zhang MM， Cheng JQ， Lu YR， et al. Use of pre-， pro- and synb-iotics in patients with acute pancreatitis：a meta-analysis[J]. World J Gastroenterol， 2010， 16(31)：3970-3978.
  42. 42. Petrov MS， Loveday BP， Pylypchuk RD， et al. Systematic reviewand meta-analysis of enteral nutrition formulations in acute pancr-eatitis[J]. Br J Surg， 2009， 96(11)：1243-1252.
  43. 43. Zhang XP， Jiang J， Yu YP， et al. Effect of Danshen on apoptosis and NF-kappaB protein expression of the intestinal mucosa of rats with severe acute pancreatitis or obstructive jaundice[J]. Hepatobiliary Pancreat Dis Int， 2010， 9(5)：537-546.
  44. 44. Zhang Z， Wang Y， Dong M， et al. Oxymatrine amelioratesL-arginine-induced acute pancreatitis in rats[J]. Inflammation， 2012， 35(2)：605-613.
  45. 45. Wang G， Sun B， Zhu H， et al. Protective effects of emodin combined with danshensu on experimental severe acute pancreatitis[J]. Inflamm Res， 2010， 59(6)：479-488.
  46. 46. Zhang XP， Wang C， Wu DJ， et al. Protective effects of ligustrazine，kakonein and Panax notoginsenosides on multiple organs in rats with severe acute pancreatitis[J]. Methods Find Exp Clin Pharmacol， 2011， 32(9)：631-644.
  47. 47. Jha RK， Ma Q， Lei Z， et al. Resveratrol ameliorates the delete-rious effect of severe acute pancreatitis[J]. Cell Biochem Biophys，.
  48. 48. Chen H， Li F， Jia JG， et al. Effects of traditional Chinese medicineon intestinal mucosal permeability in early phase of severe acute pancreatitis[J]. Chin Med J (Engl)， 2010， 123(12)：1537-1542.
  49. 49. 羅艷紅， 鐘廣偉， 趙雙平， 等. 應(yīng)用電針干預(yù)重癥早期急性胰腺炎并發(fā)腸麻痹[J]. 中國針灸， 2011， 31(2)：105-109.
  50. 50. 李杰， 李賀， 孫備， 等. 大黃聯(lián)合電針促進重癥急性胰腺炎胃腸道功能復(fù)蘇的臨床研究[J]. 中國中西醫(yī)結(jié)合雜志， 2009， 29(7)：661-662.
  51. 51. 薛奇明， 李寧， 薛平， 等. 電針“足三里”對急性胰腺炎大鼠血清促炎因子及胰腺核因子-kB活性的影響[J]. 針刺研究， 2011， 36(4)：272-277.
  52. 52. 薛奇明， 黃露， 李寧. 電針天樞穴對重癥急性胰腺炎大鼠血清促炎和抗炎因子的影響[J]. 中西醫(yī)結(jié)合學(xué)報， 2011， 9(6)：658-664.
  53. 53. 王新宇. 電針治療急性胰腺炎及對患者腸道通透性的影響[J]. 中國針灸， 2007， 27(6)：421-423.
  54. 54. An HJ， Lee JH， Lee HJ， et al. Electroacupuncture protects against CCK-induced acute pancreatitis in rats[J]. Neuroimmunomodulation， 2007， 14(2)：112-118.
  55. 55. Uhm MS， Kim YS， Suh SC， et al. Acute pancreatitis induced by traditional acupuncture therapy[J]. Eur J Gastroenterol Hepatol，.
  56. 56. 劉續(xù)寶， 蔣俊明， 黃宗文， 等. 中西醫(yī)結(jié)合治療重癥急性胰腺炎的臨床研究(附1 376例報告)[J]. 四川大學(xué)學(xué)報：醫(yī)學(xué)版， 2004， 35(2)：204-208.
  57. 57. Caronna R， Benedetti M， Morelli A， et al. Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis[J]. World J Emerg Surg， 2009， 4：45.
  58. 58. Souza LJ， Coelho AM， Sampietre SN， et al. Anti-inflammatory effects of peritoneal lavage in acute pancreatitis[J]. Pancreas， 2010， 39(8)：1180-1184.
  59. 59. Meng K， Liu Q， Dou Y， et al. Prior peritoneal lavage with hot 0.9% saline induces HSP70 expression and protects against cerule-ininduced acute pancreatitis in rats[J]. Mol Biol Rep， 2013， 40(2)：1443-1449.
  60. 60. Dong Z， Petrov MS， Xu J， et al. Peritoneal lavage for severe acute pancreatitis：a systematic review of randomised trials[J]. World J Surg， 2010， 34(9)：2103-2108.
  61. 61. Zhu Y， Yuan J， Zhang P， et al. Adjunctive continuous high-volume hemofiltration in patients with acute severe pancreatitis：a prospective nonrandomized study[J]. Pancreas， 2011， 40(1)：109-113.
  62. 62. He C， Zhang L， Shi W， et al. Coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration treatment in patients with severe acute pancreatitis[J]. 2013， 47(1)：62-68.
  63. 63. Tao J， Gong D， Ji D， et al. Improvement of monocyte secretionfunction in a porcine pancreatitis model by continuous dose depen-dent veno-venous hemofiltration[J]. Int J Artif Organs， 2008， 31(8)：716-721.
  64. 64. Zhang J， Yuan C， Hua G， et al. Early gut barrier dysfunction in patients with severe acute pancreatitis：attenuated by continuousblood purification treatment[J]. Int J Artif Organs， 2010， 33(10)：706-715.
  65. 65. Pupelis G， Plaudis H， Zeiza K， et al. Early continuous veno-venous haemofiltration in the management of severe acute pancr-eatitis complicated with intra-abdominal hypertension：retrospectivereview of 10 years’ experience[J]. Ann Intensive Care， 2012， 2(Suppl 1)：S21.
  66. 66. Hirasawa H. Indications for blood purification in critical care[J]. Contrib Nephrol， 2010， 166：21-30.
  67. 67. Bai X， Sun B， Pan S， et al. Down-regulation of hypoxia-induciblefactor-1alpha by hyperbaric oxygen attenuates the severity of acute pancreatitis in rats[J]. Pancreas， 2009， 38(5)：515-522.
  68. 68. Uysal B， Yasar M， Ersoz N， et al. Efficacy of hyperbaric oxygen therapy and medical ozone therapy in experimental acute necrotizingpancreatitis[J]. Pancreas， 2010， 39(1)：9-15.
  69. 69. Hou J， Zhu MW， He XW， et al. Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin， soluble CD14， endotoxin-neutralizing capacity and cytokines in acute necrotizing pancreatitis[J]. Can J Surg， 2010， 53(4)：241-245.
  70. 70. Yu X， Li YG， He XW， et al. Hyperbaric oxygen reduces inflammatory response in acute pancreatitis by inhibiting NF-kappaB activation[J]. Eur Surg Res， 2009， 42(2)：130-135.
  71. 71. Cuthbertson CM， Su KH， Muralidharan V， et al. Hyperbaric oxygen improves capillary morphology in severe acute pancreatitis[J]. Pancreas， 2008， 36(1)：70-75.
  72. 72. Koh SL， Tan JW， Muralidharan V， et al. The effect of hyperbaric oxygen on apoptosis and proliferation in severe acute pancreatitis[J]. HPB (Oxford)， 2009， 11(8)：629-637.
  73. 73. Comert B， Isik AT， Aydin S， et al. Combination of allopurinol and hyperbaric oxygen therapy：a new treatment in experimentalacute necrotizing pancreatitis?[J]. World J Gastroenterol， 2007，.
  74. 74. Mas N， Isik AT， Mas MR， et al. Hyperbaric oxygen-induced changes in bacterial translocation and acinar ultrastructure in rat acute necrotizing pancreatitis[J]. J Gastroenterol， 2005， 40(10)：980-986.
  75. 75. Cuthbertson CM， Christophi C. Potential effects of hyperbaric oxygen therapy in acute pancreatitis[J]. ANZ J Surg， 2006， 76(7)：625-630.
  76. 76. Deshpande A， Pant C， Pasupuleti V， et al. Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis[J]. Clin Gastroenterol Hepatol， 2012， 10(3)：225-233.
  77. 77. Dalton BR， Lye-Maccannell T， Henderson EA， et al. Proton pump inhibitors increase significantly the risk of Clostridium difficileinfection in a low-endemicity， non-outbreak hospital setting[J]. Aliment Pharmacol Ther， 2009， 29(6)：626-634.
  78. 78. Lo WK， Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth：a meta-analysis[J]. Clin Gastroenterol Hepatol， 2013， 11(5)：483-490.
  79. 79. Ratuapli SK， Ellington TG， O’Neill MT， et al. Proton pump inhi-bitor therapy use does not predispose to small intestinal bacterial overgrowth[J]. Am J Gastroenterol， 2012， 107(5)：730-735.
  80. 80. ， 17(6)：675-677.
  81. 81. ， 62(2)：397-402.

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