伴呼吸衰竭重症急性胰腺炎侵袭性真菌感染15例

Invasive fungal infection in patients with severe acute pancreatitis and respiratory failure: an analysis of 15 cases

目的:研究伴呼吸衰竭的重症急性胰腺炎(SAP)患者侵袭性真菌感染(IFI)的临床特征,为SAP治疗提供参考.方法:回顾性分析监护病房2003-06/2009-0955例伴呼吸衰竭SAP患者的临床资料,根据体液病原菌培养结果及临床表现,将其分为IFI组、细菌感染(BI)组及非感染(NI)组,比较3组APACHEⅡ评分、机械通气(MV)时间、腹内压、病原菌检出时间、MODS数≥3发生率、外科干预率、CRRT率及病死率.调查IFI组感染部位、病原菌分布等.结果:IFI率为27.27%(15/55),以腹腔真菌感染为主,占73.33%(11/15),其半数(6/11)合并呼吸机相关真菌肺炎(VAFP).IFI组与BI、NI组比较,MV时间延长(19.53d±4.88dvs14.14d±4.26d,6.23d±2.34d,均P<0.05),外科干预率升高(86.67%vs42.86%,0.00%,均P<0.05).与BI组比较,病原菌检出时间延后(10.13d±2.59d vs5.14d±2.21d,P<0.05),病死率无差异.腹腔和肺部真菌检出前存在BI.部分腹腔真菌感染混合肠球菌感染.结论:伴呼吸衰竭SAP IFI主要部位在腹腔,易合并VAFP,伴BI.应积极处理腹腔感染改善预后.

AIM：To investigate the clinical characteristics of invasive fungal infection（IFI）in patients with severe acute pancreatitis（SAP）and respiratory failure.METHODS：The clinical data for patients with SAP and respiratory failure who were treated in ICU between June 2003 and September 2009 were retrospectively analyzed.Patients were divided into three groups according to body fluid culture results and clinical features：invasive fungal infection（IFI）,bacterial infection（BI）,and non-infection（NI）.APACHE II score,length of mechanical ventilation（MV）,intra-abdominal pressure,percentage of patients developing multiple organ dysfunction syndrome（MODS）three times or more,surgical intervention,continuous renal replacement therapy（CRRT）,mortality,and time required to isolate pathogen were compared among the three groups.Affected regions and pathogen species distribution of IFI werealso investigated.RESULTS：IFI occurred in 27.27%（15/55）of patients with SAP and respiratory failure.Approximately 73.33%（11/15）of patients with IFI developed intra-abdominal fungal infection,with half of them（6/11）having ventilator-associated fungal pneumonia（VAFP）.Compared to patients with BI and NI,patients with IFI had longer MV（19.53 d±4.88 d vs 14.14 d±4.26 d,6.23 d±2.34 d,both P0.05）,and higher rate of surgical intervention（86.67%vs 42.86%,0.00%,both P0.05）.Compared to patients with BI,the time required to isolate pathogen was longer in patients with IFI（10.13 d±2.59 d vs 5.14 d± 2.21 d,P0.05）though they had similar mortality rate.Bacteria might be isolated before fungi were isolated in patients with intra-abdominal fungal infection and VAFP.Intra-abdominal fungal infection might be concomitant with enterococcal infection.CONCLUSION：The abdomen is the main region affected by IFI in patients with SAP and respiratory failure.IFI patients often develop VAFP and concomitant bacteria infections.Appropriate management of intra-abdominal infection could improve poor prognosis in patients with SAP and respiratory failure.