急性重症胰腺炎合并真菌感染分析及对策

ANALYSIS AND COUNTER MEASURES OF SEVERE ACUTE PANCREATITIS WITH FUNGAL INFECTION

目的探讨急性重症性胰腺炎(SAP)合并真菌感染特点及影响感染的高危因素。方法对1995年以来我院共收治SAP病人82例,根据病因分为两组:胆原性为(A组)46例,其他原因(饮酒、不明原因等)为(B组)36例。对患者入院时APCHEⅡ积分、肠麻痹、留置尿管、静脉营养、高血糖、肝功能障碍、应用抗生素情况等相关因素进行统计学分析。结果82例合并真菌感染22例,发生率为26.8%,A组合并真菌感染发生率21.7%,B组合并真菌感染发生率33.3%。有APCHEⅡ积分、肠麻痹、肠外营养、抗生素应用4个变量进入回归方程。四项指标危险因素与真菌感染发生率有明显相关(p<0.05)。结论对于APCHEⅡ积分(15.45±4.56)以上尤其是非胆原性SAP,肠麻痹和肠外营养≥7d、连续联合应用抗生素≥15d者应高度重视有真菌感染危险。

Objective To study the feature and high risk factors of severe acute pancreatitis（SAP） complicating fungous infection. Methods According to etiological factor 82 SAP patients in our hospital from1995 to now were divided into A group and B group, the etiological factor of A group is disease of biliary tract, B group is others （drink wine, no clear cause etc）. Correlation factors including patient＇ s APCHE 11 on admission , enteroparalysis, remaining urinary canal, intravenous nutrition, hyperglycaemia, hepatosis, using antibiotic were analyzed by statistics. Results SAP complicating fungous infection in 22 cases, incidence rate is 26.8%. The incidence rate is 21.7% in A group and 33.3% in B group. Four variance including patient＇s APCHE 11, enteroparalysis, intravenous nutrition, using antibiotic enter regression equation. The risk factors of these four indexes were correlated with incidence rate of fungous infection significantly（p 〈0. 05）. Conclusion It is high risk of fungous infection for patients that APACHE 11≥（ 15.45 ± 4. 56 ） especially the etiological factor was not disease of biliary tract, enteroparalysis and intravenous nutrition ≥7 d, continuous using antibiotic ≥15 d.