重症胰腺炎患者感染的临床分析

Clinical analysis of infections in patients with severe pancreatitis

目的分析重症急性胰腺炎(SAP)患者感染的易感因素及感染类型,指导临床正确预防及合理治疗。方法回顾性调查医院2004年2月-2013年2月收治的SAP患者的临床资料;通过56例SAP合并感染组患者与185例非感染组患者的对比与分析,探究急性胰腺炎合并感染的易感因素;通过对56例合并感染患者的病原菌检测,分析患者合并感染的感染类型。结果在241例SAP患者中死亡39例,病死率为16.18%;其中感染组56例患者中死亡22例,病死率为39.29%;非感染组185例患者死亡17例,病死率为9.19%;感染组者与非感染组患者的治疗时间、APACHEⅡ评分、CT评分、氧分压、肠功能恢复时间等指标差异有统计学意义(P<0.05),是SAP合并感染的易感因素;56例SAP合并感染患者中,40例确诊有细菌感染,细菌感染率为71.43%。54例有真菌感染,真菌感染率为96.43%;其中38例为细菌与真菌混合感染。结论急性重症胰腺炎合并感染患者病死率高,通过对其易感因素及感染类型的分析,积极做好预防措施以及临床合理治疗,对提高重症胰腺炎合并感染患者的生存率有重要意义。

OBJECTIVE To investigate the predisposing factors for infections in the patients with severe acute pancreatitis（SAP）and analyze the types of infections so as to provide guidance for reasonable clinical prevention and treatment of the infections.METHODS The clinical data of the patients with SAP who were treated in the hospital from Feb 2004 to Feb 2013 were retrospectively investigated.A comparative study was conducted for 56 SAP patients complicated with infections and 185 SAP patients without infections.The predisposing factors for the SAP complicated with infections were observed,the pathogens were detected in the 56 patients complicated with infections,and the types of the complicated infections were analyzed.RESULTS Of the 241 patients with SAP,39 died,with the mortality rate of 16.18%;totally 22 of 56patients died in the infection group,with the mortality rate of39.29%,and 17 of 185patients died in the non-infection group,with the mortality rate of 9.19%.There was significant difference in the treatment time,APACHEⅡ score,CT score,partial pressure of oxygen,or recovery time of intestinal function between the infection group and the non-infection group（P〈0.05）,they were the predisposing factors for the SAP complicated with infections.Of 56 SAP patients complicated with infections,40 were confirmed as the bacterial infections,with the incidence of bacterial infections of 71.43%,and 54 were confirmed as the fungal infections,with the incidence of fungal infections of 96.43%;totally 38 cases had the mixed bacterial and fungal infections.CONCLUSIONThe mortality rate of the SAP patients complicated with infections is high.It is of great significance to analyze the predisposing factors for the infections and the types of infections,actively take the prevention measures,and conduct reasonable clinical treatment so as to raise the survival rate of the SAP patients complicated with infections.