重症急性胰腺炎并发菌血症的临床分析

Clinical study of the patients with severe acute pancreatitis complicated by bacteremia

目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)并发菌血症的临床特点。方法回顾性分析26例SAP并发菌血症患者,同时选取26例3次以上血培养均为阴性的SAP患者作为对照组,比较两者的细菌谱构成及药敏结果、治疗经过、并发症发生率及病死率。结果 SAP患者并发菌血症,主要细菌:大肠埃希菌(30.8%)、鲍曼/溶血不动杆菌(23.1%)、粪肠球菌(15.4%)。26例中并发急性呼吸窘迫综合征(ARDS)15例(57.7%),多脏器功能衰竭(MODS)13例(50.0%),并发其他部位感染15例(57.7%)。随访3个月死亡11例(42.3%);对照组并发ARDS4例(15.4%),MODS3例(11.5%),死亡3例(11.5%),并发其他部位感染6例(23.1%)。两组差异有统计学意义(P﹤0.05)。结论 SAP并发菌血症常同时合并其他部位感染,其MODS及ARDS严重并发症的发生率、病死率较高。

Objective To analyze the clinical characteristics of the patients with severe acute pancreatitis（SAP） complicated by bacteremia.Methods Based on retrospective study,26 patients with SAP complicated by bacteremia,the other 26 SAP patients in the control group with negative blood cultures more than three times.Compared bacterial spectrum,therapeutic process,incidence rate of complicating disease and mortality between the two groups.Results The most common bacteria of patients with SAP complicated by bacteremia were Escherichia coli（30.8%）,Acinetobacter baumannii（23.1%）,Enterococcus faecalis（15.4%）.Fifteen cases（57.7%） complicated by other body-parts infection,15 cases（57.7%） complicated by acute respiratory distress syndrome（ARDS）,13 cases（50.0%） complicated by multiple organ dysfunction syndrome（MODS）.Eleven cases（42.3%） died during the next 3 months of follow-up.In the control group,6 cases（23.1%） complicated by other body-parts infection,4 cases（15.4%） complicated by ARDS,3 cases（11.5%） complicated by MODS,3 cases（11.5%） died.There was a statistically significant difference between the two groups（P 〈0.05）.Conclusion The patients with SAP complicated by bacteremia often concurrently complicate with other body-parts infection,the prevalence of MODS,ARDS and the mortality is significantly higher than the control group.