急性重症胰腺炎并发腹腔感染者的临床表现与治疗

Clinical manifestations and treatment of patients with acute severe pancreatitis complicated with abdominal infection

目的对急性重症胰腺炎并发腹腔感染的临床表现进行探讨,针对常见病原菌及抗菌药物敏感性进行统计,为急性重症胰腺炎诊治提供理论依据。方法选择本院2017年5月至2018年4月收治的急性重症胰腺炎合并腹腔感染患者158例,在回顾性分析其临床表现的基础上,研究病原菌培养及抗菌药物敏感性。结果 158例患者共检出168株病原菌,其中存在多重感染患者。最多的是革兰阴性菌,共检出130株(77.4%),其次是革兰阳性菌,共检出32株(19.1%),最低的是真菌,共检出6株(3.6%)。通过多因素Logistics回归分析,得出重症急性胰腺炎腹腔感染危险因素包括APACHEⅡ评分上升、Ranson评分上升、脏器功能损伤、休克(P<0.05)。结论重症急性胰腺炎腹腔感染危险因素包括APACHEⅡ评分上升、Ranson评分上升、脏器功能损伤、休克。急性重症胰腺炎合并腹腔感染患者临床表现较为典型,明确诊断后需进行抗菌药物经验性治疗,并开展药品试验及病原菌培养,然后依据结果对用药进行调整。

Objective To investigate the clinical manifestations of acute severe pancreatitis complicated with abdominal infection, and to analyze the sensitivity of common pathogens and antibiotics, and provide a theoretical basis for the diagnosis and treatment of acute severe pancreatitis. Methods A total of 158 patients with acute severe pancreatitis complicated with abdominal infection admitted to our hospital from May 2017 to April 2018 were enrolled.Based on the retrospective analysis of clinical manifestations, pathogen culture and antimicrobial sensitivity were studied. Results A total of 168 pathogens were detected in 158 patients, including multiple infections.The most common Gram-negative bacteria were 130 strains (77.4%), of which Gram-positive bacteria were detected, 32 strains (19.1%) were detected, and the lowest was fungi.A total of 6 strains (3.6%) were detected.Multivariate logistic regression analysis showed that the risk factors of abdominal infection in severe acute pancreatitis included APACHE II score, Ranson score, organ damage, and shock (P<0.05).Conclusion Risk factors for abdominal infection in severe acute pancreatitis include increased APACHE Ⅱ score, increased Ranson score, organ damage, and shock.The clinical manifestations of patients with acute severe pancreatitis complicated with abdominal infection are typical.After the diagnosis, it is necessary to carry out empirical treatment of antibacterial drugs, and carry out drug testing and pathogen culture, and then adjust the medication according to the results.