重症急性胰腺炎感染的危险因素分析和预防性抗生素的作用

Risk factor analysis of and effects of antibiotic prophylactics on infection in patients with severe acute pancreatitis

目的 了解重症急性胰腺炎感染的危险因素和预防性抗生素的作用。方法 采用非条件逻辑回归分析方法对我院 10 8例病例进行回顾性分析。结果 严重肠麻痹和胰周坏死程度因素(CTBalthazar评分 )发生感染的机会比 (OR)分别为 7 0 8和 2 3 4 (P <0 0 0 1) ,而年龄、病因、腹水、Ran son评分和深静脉营养等因素发生感染的机会比均无统计学意义。与氨苄青霉素组比较 ,头孢一代、头孢三代和喹诺酮类抗生素组的感染率的相对危险降低 (relativeriskreductions)分别为 3 1 63 %、5 2 14 %和 5 1 11%。结论 严重肠麻痹和广泛的胰周坏死与感染的关系明显 ,而与年龄、Ranson评分、病因、深静脉营养、腹水等因素的关系不明显 ;头孢三代和喹诺酮类抗生素有预防感染的作用。

Objective To investigate risk factors of and effects of antibiotic prophylactics on infection in patients with severe acute pancreatitis (SAP). Methods The data of 108 cases of SAP with or without infection were retrospectively analyzed with the single factor and controlled confounding logic regression. Results The odds ratios (OR) of severe paralytic ileus and pancreatic necrosis (CT Balthazar Degree) for possibilities of infections were 7.08 and 2.34, respectively (P<0.001). The values of OR of other factors for infections such as age, etiology, ascites, Ranson score and total parenteral nutrition etc. were very low and of no statistical significance. Compared with infecting rate in patients treated with prophylactic ampicillin, the relative risk reductions of infecting rate in patients treated with cephalosporin of 1st generation, cephalosporin of 2nd generation and quinolons were 31.63%, 52.14% and 51.11% respectively. Conclusions Occurrence of infections may be related to severe paralytic ileus and pancreatic necrosis but not age, Ranson score, etiology, total parenteral nutrition and ascites. Prophylactic cephalosporin of 3rd generation and quinolons are effective in preventing the pancreas from infections.