摘要

背景:抗生素在组织中达到杀菌浓度的能力取决于许多因素，包括组织组成和区域灌注。虽然坏死性胰腺炎的特征是至少96小时内胰腺坏死进展和微循环改变，但这些变化对胰腺中抗生素浓度的影响尚未被研究。目的:在动物模型中测定和比较亚胺培南和头孢噻肟在急性坏死性胰腺炎不同阶段的胰腺组织浓度，该动物模型已被证明能够密切模仿严重人类胰腺炎的病理形态学和细菌学特征。方法:大鼠急性坏死性胰腺炎采用标准化导管内输注糖去氧胆酸和静脉注射天蓝素诱导。在胰腺炎诱导后6小时(n = 16)和48小时(n = 16)，动物随机接受亚胺培南或头孢噻肟静脉治疗。注射抗生素15分钟后，动物被杀死。取血及胰头测定血清及组织中亚胺培南或头孢噻肟;准备胰腺脾部进行组织学检查。在另一组同样治疗的动物中，在急性坏死性胰腺炎诱导前和抗生素治疗时，通过活体显微镜评估胰腺毛细血管血流(PCBF)。结果:亚胺培南在急性坏死性胰腺炎的初始阶段积聚在胰腺中，其特征是明显的水肿和PCBF减少，并在疾病后期随着水肿的消退和腺泡细胞坏死的进展趋于减少。 Concentrations of cefotaxime are low in oedematous pancreatic tissue early after induction of acute necrotising pancreatitis and increase with the resolution of oedema and normalisation of PCBF. CONCLUSIONS: Concentrations of antibiotics in the pancreas vary in acute necrotising pancreatitis, depending on changes in pancreatic tissue morphology and capillary blood flow. This suggests that antibiotic tissue concentrations may not be consistent from one agent to another and that efficacy of antibiotics in acute pancreatitis cannot be estimated solely on the basis of their pharmacological and microbiological properties.