41例急性重症胰腺炎患者合并腹腔感染的危险因素分析

41 cases of acute severe pancreatitis,abdominal infection risk factor analysis and pathogen separation

目的探讨急性重症胰腺炎(SAP)并发腹腔感染的危险因素及病原学情况。方法回顾性分析该院2011年1月至2015年12月收治的41例急性SAP并发腹腔感染患者(观察组),选择同期收治的79例未合并腹腔感染的患者作为对照组,分析2组患者各项指标的差异性,对相关指标行Logistic回归分析,分析感染危险因素,探讨感染病菌分离情况。结果单因素分析显示,急性SAP患者合并腹腔感染危险因素包括腹部CT提示坏死,发生肠功能障碍,运用机械通气,并发多器官功能障碍综合征(MODS),住院天数,APACHEⅡ评分,C反应蛋白(CRP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST),血钙水平增加等,而多因素分析表明,住院天数≤20d(OR=35.794)、AST≤90 U/L(OR=251.788)、血钙>1.9 mmol/L为参照(OR=59.881)为急性SAP伴腹腔感染的易感因素。感染病原菌主要为革兰阴性杆菌,占72.73%,其次为革兰阳性球菌(20.45%),真菌最少(6.82%)。结论急性SAP患者合并腹腔感染与多种因素密切相关。

Objective Studied the infection risk factors and etiology separation conditions of patients with severe acute pancreatitis complicated with abdominal cavity,in order to help clinical diagnosis and treatment and reduce the infection rate.Methods The clinical data of 41 in patients from January 2011 to December 2015,with severe acute pancreatitis complicated with abdominal cavity infection,were retrospectively analyzed.Another 79 cases of the same period of unincorporated abdominal cavity infection patients were as control group.Compared the difference between the two groups.Some indicators were studied by Logistic regression analysis.Analysised the risk factors of infection and infection group etiology separation.Results Single factor analysis showed that risk factors of patients with severe acute pancreatitis complicated by abdominal cavity infection include abdominal CT reporting necrosis,bowel dysfunction,using mechanical ventilation,complicated with MODS,hospitalization days,APACHEⅡ score,CRP,ALT,AST,Ca,etc..And multi-factor analysis showed that predisposing factors of severe acute pancreatitis with abdominal cavity infection were the number of days in hospital for 20 or less（OR=35.794）,AST for 90（U/L） or less（OR=251.788）,calcium in serum was more than 1.9（mmol/L）（OR=59.881）.Pathogenic bacteria are mainly gram-negative bacteria infection group,accounting for 72.73%,followed by gram-positive bacteria （20.45%） and fungus（6.82%）.Conclusion Severe acute pancreatitis patients with abdominal cavity infection were closely related to many factors.