[The prevention of infection complicating acute necrotizing pancreatitis:an experimental study]

To observe the effects of 5 intervention measures on infection complicating acute necrotizing pancreatitis (ANP) in dogs and rats.

A lethal model of ANP was reproduced by infusion of artificial bile into the biliopancreatic duct. Animals were divided randomly into: ANP group (no treatment); Chinese medicine group ("Qing Yi Tang"); Bifidobacterium mixture group; purgation group (MgSO(4)); selective decontamination of the digestive tract (SDD) group; and somatostatin group. The pancreas and intestine were observed morphologically and tight junction on ileum epithelia was assessed on cryofracture replicas. Blood and/or tissue levels of DAO and D-lactic acid and uric contents of lactulose/mannitol (L/M), served as indicators of gut barrier function, were measured at various time points. Intestinal flora and incidence of bacterial translocation (BT) to organs were examined.

In early stage of ANP, mucosal and epithelial tight junction damage and flora disturbance occurred in the gut. In addition, the gut barrier function indicators deteriorated. The BT rates were as high as 78.6% (canine) and 59.5% (rat). Treatment with Chinese medicine markedly improved gut barrier function and reduced BT rate (32.1% - 37.0%). Having similar purgative response as Chinese medicine, MgSO4 did not show any beneficial effect on gut barrier protection and the incidence of BT was not reduced. In bifidobacterium mixture and SDD group, flora balance was preserved well and similar results as Chinese medicine were obtained. The BT rates of these two groups decreased to 33.9% and 33.3%, respectively. Somatostatin markedly blunted pancreatic tissue injury and ameliorated gut barrier damage during early phase of ANP. All intervention measures except for purgation also decreased mortalities (14.3% - 35.3%, compared with 58.8% of the no treatment group).

Treatment with Chinese medicine, bifidobacterium mixture, SDD and somatostatin attenuated gut barrier damage and BT after ANP, and could be used to prevent secondary infection after ANP, but purgation alone is not effective.