重症急性胰腺炎并发腹腔感染的相关危险因素及病原菌

Risk Factors and Pathogenic Bacteria Screening of Severe Acute Pancreatitis Complicated with Abdominal Infection

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菌。方法:200例SAP患者,分为感染组(n=46,并发腹腔感染)和非感染组(n=154),所有患者均按SAP治疗原则给予非手术保守治疗、必要时转为手术治疗;比较2组患者性别、年龄、病因、就诊时间、禁食时间、肠麻痹时间,比较入院时的白细胞计数(WBC)、急性生理与慢性健康Ⅱ(APACHEⅡ)评分、机械通气时间、低氧血症、血钙、血糖、血肌酐及血清白蛋白,将有差异的指标进行多因素Logistic回归分析,分析SAP继发腹腔感染的独立危险因素,并对46例SAP并发腹腔感染患者的腹水和胰腺炎坏死组织进行培养并检测病原菌,同时观察2组患者治疗效果。结果:两组患者的禁食时间、肠麻痹时间、APACHEⅡ评分、机械通气时间、低氧血症比例比较,差异有统计学意义(P<0.01);其余指标比较,差异无统计学意义(P>0.05);患者禁食时间、肠麻痹时间、APACHEⅡ评分、机械通气时间、低氧血症是SAP继发腹腔感染的独立危险因素(P<0.05);培养后共检出48株病原菌,其中革兰阴性菌33株(68.75%),革兰阳性菌10株(20.83%),真菌5株(10.42%);与感染组比较,未感染组患者平均住院时间、住院时间、ICU监护治疗、手术介入率及死亡率低于感染组(P<0.01)。结论:SAP患者禁食时间、肠麻痹时间、APACHEⅡ评分、机械通气时间、低氧血症都是SAP并发腹腔感染的危险因素,检出的病原菌以革兰阴性菌为主。

Objective： To investigate the risk factors and pathogenic bacteria screening of severe acute pancreatitis（ SAP） complicated with abdominal infection. Methods： 200 patients with SAP were divided into infection group（ n = 46,concurrent abdominal infection） and non-infection group（ n =154）. All patients were treated with non-operative conservative treatment according to the principle of SAP treatment,and then converted to surgical treatment if necessary. Sex,age,etiology,visit time,fasting time,intestinal paralysis time were compared between the two groups. The white blood cell count（ WBC）,acute physiology and chronic health Ⅱ（ APACHE Ⅱ） score,mechanical ventilation time,hypoxemia,blood calcium,blood sugar,serum creatinine and serum albumin were compared at admission. Multivariate Logistic regression analysis was carried out to analyze the independent risk factors of abdominal infection secondary to SAP. The ascites and necrotic tissues of 46 patients with SAP complicated with peritoneal infection were cultured. The therapeutic effects of the two groups were observed at the same time. Results： The fasting time,intestinal paralysis time and APACHE Ⅱ score,mechanical ventilation time and hypoxemia ratio were compared in two groups,and the difference was statistically significant（ P 〈0. 01）. There was no significant difference between the other indexes（ P 〉0. 05）. Time of fasting,time of intestinal paralysis,APACHE Ⅱ score,time of mechanical ventilation and hypoxemia were independent risk factors of abdominal infection secondary to SAP（ P 〈0. 05）. After culture,48 strains of pathogenic bacteria were detected,including 33 Gram-negative bacteria（ 68. 75%）,10 Gram-positive bacteria（ 20. 83%） and 5 fungi（ 10. 42%）. Compared with the infection group,the average hospitalization time,the time of hospitalization,the ICU monitoring,the operation intervention rate and the mortality rate of the uninfected group were lower than that of the infection group（ P 〈0. 01）. Conclusion： Time of fasting,time of intestinal paralysis and APACHE Ⅱscore,time of mechanical ventilation and hypoxemia are all the risk factors of SAP complicated with abdominal infection,and gram-negative bacteria are the main pathogens.