重症急性胰腺炎继发脓毒症危险因素分析

Risk factors of sepsis in severe acute pancreatitis

目的分析重症急性胰腺炎（SAP）继发脓毒症的危险因素以及病原菌特点，为临床减少重症急性胰腺炎合并脓毒症提供参考依据。方法回顾性分析2017年07月至2018年05月间，湖南省人民医院肝胆胰脾外科以及外科重症监护室收治的64例重症急性胰腺炎患者临床资料，并分析继发脓毒症患者病原菌分布特点。Logistic回归分析脓毒症的危险因素数据，所有数据采用SPSS19．0软件进行统计分析。结果64例重症急性胰腺炎患者中发生脓毒症患者共检出39株病原菌，其中以细菌为主共34株占87．17％，在SAP患者中，中心静脉留置导管时间≥10天、禁食时间≥10天、胃肠功能障碍时间≥5天、入院WBC计数（×10^9/L）≥20、血浆C-反应蛋白≥20、低氧血症、CT表现为胰腺坏死、有全身炎症反应综合征、合并多器官功能衰竭的差异有统计学意义（P〈0．05），通过Logistic回归分析，发现重症急性胰腺炎患者禁食时间、胃肠功能障碍时间、中心静脉置管留置时间、人院WBC计数、血浆C-反应蛋白、CT表现为胰腺坏死、合并低氧血症、合并多器官功能障碍综合征是发生脓毒症的独立危险因素（P〈0．05）。结论重症急性胰腺炎患者并发脓毒症危险因素较多，根据患者临床情况，给予个性化治疗方式，选择适当的抗菌药物，有利于减少脓毒血症发生，从而改善重症急性胰腺炎预后。

Objective To analyze the risk factors and pathogenic bacteria characteristics of severe acute pancreatitis （SAP） secondary sepsis, and to provide reference basis for clinical reduction of severe acute pancreatitis complicated with sepsis. Methods The clinical data of 64 patients with severe acute pancreatitis admitted to the hepatobiliary, pancreatic and splenic surgery and surgical intensive care unit in people＇s hospital of hunan province from July 2017 to May 2018 were retrospectively analyzed, and the distribution characteristics of pathogenic bacteria in sepsis patients were analyzed. Logistic regression was used to analyze the risk factors of sepsis. All data were analyzed statistically using SPSS19. 0 software. Results 64 cases of patients with sepsis in patients with severe acute pancreatitis were detected with 39 strains of patho- genic bacteria, which is given priority to with bacteria, a total of 34 strains （87. 17%）, central venous in- dwelling catheter time in SAP patients, 10 days, fasting time for 10 days or more, or gastrointestinal dysfunction time 5 days or more, the WBC count （×10^9/L） or admission, plasma C - reactive protein acuity 20, hypoxemia, CT manifestation of pancreatic necrosis, systemic inflammatory response syndrome, combination of multiple organ failure of the difference was statistically significant （ P 〈 0. 05 ）, by Logistic regression analysis, It was found that fasting time, gastrointestinal dysfunction time, central venous catheterization time, WBC count on admission, plasma c-reactive protein, CT manifestations of pancreatic necrosis, hypoxemia and multiple organ dysfunction syndrome were independent risk factors for sepsis （P〈0. 05 ）. Conclusions There are many risk factors for sepsis in patients with severe acute panereatitis. According to the clinical situation of patients, personalized treatment and appropriate antimicrobial agents are given to help reduce the incidence of sepsis and thus improve the prognosis of severe acute pancreatitis.