重症急性胰腺炎继发腹腔内感染的抗生素治疗

The antibiotic treatment of severe acute pancreatitis complicated abdominal infection

目的探讨重症急性胰腺炎 (SAP)继发腹腔内感染的抗生素治疗效果。方法将39例伴有腹腔内感染的SAP患者根据感染发生的时间不同分为早期组和晚期组 ,均给予亚胺培南 西司他丁 (泰能 )治疗和 (或 )手术治疗 ,并比较 2组的临床疗效。结果总共分离 83株病原菌 ,其中革兰阴性菌占 84% ,对泰能的敏感率为 80 % ;革兰阳性菌占 16 % ,均对泰能耐药。早期组治愈率为5 3% ,晚期组为 86 % (P =0 0 2 ) ;早期组细菌清除率为 47% ,晚期组为 82 % (P =0 0 2 ) ;早期组生存率为 77% ,晚期组为 95 % (P =0 0 8) ;早期组重新感染发生率为 5 8% ,晚期组为 37% (P =0 16 )。结论泰能对SAP继发腹腔内感染有较好的临床疗效 。

Objective To evaluate antibiotic therapy for the treatment of intraabdominal infection secondary to severe acute pancreatitis.Methods 39 SAP patients with intraabdominal infection were devided into 2 groups: early infection group (early group) and late infection group (late group) according to the onset time of infection. All patients received imipenem and or surgical treatment, and results were compared between the two groups. Results 83 strains of pathogen were isolated among which Gram negative bacteria accounting for 84%, with a ratio of sensitivity to imipenem of 80%; Gram positive bacteria taking up 16%, all were resistant to imipenem. The cure rate was 53% in eraly group and 86% in late group(P=0.02); The rate of bacteria clearance was 47% in early group and 82% in late group(P=0.02). The survival rate of patients in early group was 77% and in late group was 95%(P=0.08); The reinfection rate in early group was 58% and in late group was 37%(P=0.16). Conclusion Imipenem is effective in the treatment of intraabdominal infection secondary to severe acute pancreatitis,and repeated surgical intervention is still necessary for patietns in early infection group.