重症急性胰腺炎继发胰腺感染的危险因素和感染特点分析

Risk factors and infection characteristics of secondary pancreatic infection in severe acute pancreatitis

目的研究重症急性胰腺炎继发胰腺感染的危险因素和感染特点。方法采用1：1配对病例对照研究，收集49对病例（SPI组）和对照（NSPI组），危险因素筛选用条件Logistic回归分析。结果（1）单因素分析中筛出7项危险因素，其中低蛋白血症时间长、中心静脉置管时间长、激素经多因素分析与继发的胰腺感染相关。（2）SPI组胰腺脓肿居首位；胰腺感染发生在2周内的占22．5％，4周及其以后的占71．4％。（3）SPI组总共培养出病原菌81株（肠道菌占43．2％），革兰阴性菌、革兰阳性菌、真菌分别占55．6％、27．2％、17．3％。结论长时间低蛋白血症、长时间中心静脉置管和激素是继发胰腺感染的独立危险因素。革兰阴性菌是继发胰腺感染的常见病原菌。

Objective To explore risk factors and infection characteristics of secondary pancreatic infection in severe acute panereatitis （SAP）. Methods A clinical data of 49 patients with secondary pancreatic infection in severe acute panereatitis（ SPI group）were matched with 49 patients without infection in severe acute pancreatitis （ NSPI group） between January 2003 and December 2005. The two groups were analyzed by a case-control study. Conditional Logistic regression model univariate and multivariate were used to screen out risk factors. The types of infection, the peak infection and the bacteria spectrum were analyzed in SPI group. Results （ 1 ） In univariate Logistic regression analysis, 7 factors including continuous hypoalbuminemia,prolonged time of central venous catheter, usage of hormone, high APACHE Ⅱ scores, multi-antibiotics,intestine dysfunction and continuous hyperglycemia were selected out. Moreover, the first three were statistically significant in multivariate Logistic regression analysis. （2）Pancreatic abscess ranked first in SPI group. Of all the pancreatic infection,22. 5% occurred within two weeks and 71.4% occurred in the 4th week or later. （3） In SPI group,81 strains of microorganisms were cultured, including 45 strains of gram-negative bacteria （ 55.6% ）, 22 strains of gram-positive bacteria （ 27.2% ） , and 14 strains of fungi （17.3%）. The common gram-negative bacteria were Escheriehia eoli, and the common gram-positive bacteria were Staphylococci and Enterococci. The fungi included Monilia and Yeastoid fungus. Further study revealed that 35 strains of all the microorganisms were intestinal bacteria （43. 2% ）. Conclusions Continuous hypoalbuminemia, prolonged time of central venous catheter and usage of hormone were independent risk factors of SPI. The main type of infection was pancreatic abscess. Gram-negative bacteria, were the common bacteria causing secondary pancreatic infection.