48例重症急性胰腺炎合并真菌感染的临床分析

Fungal Infection: Analysis of 48 Cases with Severe Acute Pancreatitis

目的 探讨重症急性胰腺炎 (SAP)合并真菌感染临床特征及防治方法。方法 回顾总结 4 8例 SAP合并真菌感染临床资料。结果 SAP真菌感染发生率及病死率分别为 38.1%和 4 3.7% ;本组病情危重 ,ICU留治及病程长、需多次手术打击 ,长期留置各种导管和机械通气、肠外营养、大量输血、抗酸剂及广谱抗生素治疗等 ;念珠菌感染占 6 6 .7% ,全身性感染最常见 ,其次为呼吸道、腹腔和泌尿道。结论 SAP为真菌感染高危人群 ,病死率高 ,缺乏特异症状 ,应行病原学监测和防治相结合措施 ,尽量降低危险因素 ,加强支持治疗以增强机体免疫力 ,防止肠道菌群移位和医源性感染 ,及合理抗真菌治疗。

OBJECTIVE To investigate the clinical characteristic of severe acute pancreatitis (SAP) with fungal infection (FI) and its therapeutic strategy. METHODS We retrospectively analyzed the clinical characteristic of 48 SAP cases with FI. RESULTS The morbidity and mortality of SAP with FI were 38.1% and 43.7%, (respectively.) Patients with FI were critical, had a long ICU or hospital stay, experienced many times operation or a long time with various catheterization, mechanical ventilator, total parenteral nutrition, blood transfusion, anti-acid drugs or broad spectrum antibiotics. The Candida infection accounted for 66.7% and the incidence of infection descended by systemic, respiratory tract, abdomen cavity and urinary system. CONCLUSIONS SAP (patients) are at risk of FI which have a high morbidity and mortality. Pathogen monitoring is needed due to lack of the clinical characteristic sign and symptom. It is important to carry out the measures with prevention and treatment together, which include decreasing the risk factors, giving effective supportive therapy to enhance the immunity, preventing the intestinal bacterial translocation or nosocomial infection and giving antifungal therapy properly.