继发性胰腺感染对重症胰腺炎患者预后的影响

Impact of secondary pancreatic infection on the prognosis of patients with severe acute pancreatitis: an analysis of 60 cases

目的 观察继发性胰腺感染 (SPI)对重症急性胰腺炎 (SAP)患者预后的影响。方法 回顾性研究 1980年 1月 1日— 1999年 12月 31日收治的 6 0例 SAP患者的临床资料 ,分析与 SPI发生相关的情况。结果 6 0例 SAP患者发生 SPI2 9例 ,未发生 SPI(NSPI) 31例 (4 8.3%比 5 1.7% ) ,两组患者在性别、平均年龄、Ranson分值、中华医学会 (CMA)高危因素分值等方面没有明显差异 ,但 SPI患者的平均住院时间、住院费用、急性生理与慢性健康状况评价体系 (APACHE )分值、发热天数、院外滞留时间、白细胞升高持续天数、发病到排便的时间、手术次数等均明显高于 NSPI患者。其中 SPI患者死亡 7例 ,NSPI患者死亡 1例 (病死率 2 4 .14 %比 3.2 3% )。病原菌调查发现 ,SPI组单一感染 14例 (占 4 8.3% ) ,混合感染 15例 (占 5 1.7% ) ;病原菌种类 :肠杆菌科 2 7例 (埃希氏菌属 2 5例 ,克雷伯氏菌属 1例 ,摩根氏菌属 1例 ) ,假单胞菌属 8例 (铜绿假单胞菌 7例 ,施氏假单胞菌 1例 ) ,霉菌 2例 ,其它类型细菌 5例 (枯草芽孢杆菌 2例 ,革兰厌氧球菌 1例 ,醋酸钙不动杆菌 1例 ,表皮葡萄球菌 1例 ) ,仅有 2例血培养发现大肠杆菌。结论 SPI的实质是肠源性感染 ,且严重影响了 SAP患者的预后 。

Objective To investigate the impact of secondary pancreatic infection(SPI) on the prognosis of patients with severe acute pancreatitis(SAP). Methods Clinical data of 60 patients with SAP(January 1, 1980-December 31, 1999), especially the data at the onset of SPI, were retrospectively amalyzed. Results Sixty patients were divided into two groups: SPI group(29 cases) and non-SPI group(31 cases). There was no significant difference in gender, average age, scores of Ranson and of high risk factors of China Medical Association between two groups, but the average stay days in hospital, payment, acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores, days of fever, prehospital days, days of high white blood cell(WBC) count, the duration of comstipation after the onset of SAP and average times of operation were significantly higher in SPI group than that of non-SPI group. Fatality rate of SPI group (7/29, 24.14%) was higher than that of non-SPI(1/31, 3.23%). There were 14 cases of infection with single microorganism (48.3%) and 15 cases of mixed infection (51.7%) in SPI group. Twenty-2seven patients were infected with bacteria of Enterobacteriaecae (Escherichia 25, Klebsiella pneumoniae 1, Proteus morgani 1), 8 with bacteria of Pseudomonas (P. aeruginosa 7, P. stanieri 1), 2 with fungus, 5 with other bacteria(Bacillus subtilis 2, Tetracoccus 1, Acetobacteraceae 1, Staphylococcus epidermidis 1) in SPI group. Only in 2 patients with infective pancreatic necrosis the blood culture was pasitive(Escherichia coli). Conclusion These results showed that the major source of SPI is entergenous, and SPI would affect the prognosis of SAP patients. With the present therapeutic regimes it was hard to prevent entergenous infections. It is necessary to find a new strategy.