重症急性胰腺炎的感染特点

Infectious characteristics of severe acute pancreatitis.

目的 分析重症急性胰腺炎 (SAP)感染的特点。方法 回顾性分析 72例SAP病人感染率、部位、病原菌及预防性抗生素的作用。结果 SAP病人感染率 4 2 7% ,感染者病死率增加 (5 5 9%vs 31 6 % ,P <0 0 5 )。感染部位依次为肺部、腹腔、泌尿道、血液、胆道。细菌占 72 % ,常见菌为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌 ;真菌占 2 8% ,主要为白色念珠菌 (10 /2 1,5 0 % )。 19例发生多重感染 ,多重感染者病死率增加(6 1 2 %vs 30 8% ,P >0 0 5 ) ,住院时间显著延长 [(2 8 5± 13 7)天vs (17 1± 8 3)天 ,P <0 0 5 ]。预防性使用碳青酶烯类发生真菌感染增加 (2 8 1%vs 7 3% ,P <0 0 5 )。结论 SAP原发性和继发性感染不同 。

Objective To analyse the infectious characteristic of severe acute pancreatitis(SAP).Methods The data of 72 cases who were diagnosed as SAP were retrospectively analysed,and the infectious morbidity,position,pathogene and the effect of prophylactic antibiotic were analyzed.Results Infectious rate in SAP was 42 7%,mortality in those infected increased(55 9% vs 31 6%,P<0 05);infectious positions were lungs,abdominal cavity,urinary tract,blood,biliary tract in turn.Bacteria accounted for 72% and fungi accounted for 28% in pathogenes.Escherichia coli,pseudomonas acruginosa,staphylococcus aureus and candida albicans were the most common pathogenes.19 cases got multiple infection,in which mortality increased(61 2% vs 30 8%,P>0 05)and hospital stay prolonged[(28 5±13 7)d vs (17 1±8 3)d,P<0 05].Prophylactic carbapenems increased the chance of fungal infection(28 1% vs 7 3%,P<0 05).Conclusion Primary and secondary infections in SAP were different ,we should select prophylactic antibiotics properly.