重症急性胰腺炎并发深部真菌感染21例分析

Fungal infection in severe acute pancreatitis： analysis of 21 cases.

目的探讨SAP并发深部真菌感染的易感因素以及防治的方法。方法分析1998年9月至2004年10月收治的81例SAP患者资料，其中并发深部真菌感染的21例作为真菌感染组，其余60例作为非感染组，比较两组患者的诊治方法与措施，分析真菌感染的危险因素。结果经糖皮质激素应用、腹腔灌洗、胃肠减压等一系列诊治措施，真菌感染组19例患者病愈出院，2例死亡。两组在糖皮质激素应用、中心静脉置管、全胃肠外营养、空肠营养、呼吸机支持、腹腔灌洗和囊肿穿刺等方面差异显著（P〈0．05）。结论糖尿病、老年、呼吸机支持和重症监护客观因素等为真菌感染的危险因素。合理应用抗生素和预防性应用抗真菌药物可以减少感染机会，提高SAP的救治存活率。

Objective To investigate the risk factors for deep fungal infection （DFI） in severe acute pancreatitis （SAP）. Methods The medical records of 81 SAP cases admitted from Sep. 1998 to Oct. 2004 were studied, the clinical characteristics and the course of treatment were compared between two groups （SAP with DFI： 21 cases; SAP without DFI： 60 cases） to identify the risk factors for fungal infection. Results Of all 21 cases, 19 cases with fungal infection were cured with administration of glucocorticosteroid, peritoneal lavage and gastrointestinal decompression, but 2 patients died. The two groups were significantly different in the administration of glucocorticosteroid, central venous catheterization, peritoneal lavage, mechanic ventilation, total parenteral nutrition, pseudocyst drainage. Conclusions Risk factors for DFI in patients with SAP included diabetes, advanced age, mechanic ventilation, intensive care settings. With rational use of antibiotics and antifungal drug, the infection rate may be reduced and the survival of SAP may be improved.