上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (10): 1267-.doi: 10.3969/j.issn.1674-8115.2010.10.020

• 论著（临床研究） • 上一篇    下一篇

暴发性急性胰腺炎早期感染特点分析

黄 洁, 毛恩强   

  1. 上海交通大学 医学院附属瑞金医院外科重症监护病房, 上海 200025
  • 出版日期:2010-10-25 发布日期:2010-10-27
  • 通讯作者: 毛恩强, 电子信箱: maoeq@yeah.net。
  • 作者简介:黄 洁（1978—）, 男, 主治医师, 硕士；电子信箱: seaky1229@hotmail.com。

Analysis of characteristics of early infections in patients with fulminant acute pancreatitis

HUANG Jie, MAO En-qiang   

  1. Department of Surgical Intensive Care Unit, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2010-10-25 Published:2010-10-27

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摘要：

目的 探讨暴发性急性胰腺炎（FAP）患者早期感染的临床和细菌学特点。方法 回顾性分析82例外科重症监护病房收治的FAP患者的病史资料，比较发病14 d内继发感染患者（早期感染组，n=51）与非感染患者（非感染组，n=31）感染相关因素和28 d病死率，分析早期感染组患者的感染与细菌学特点。结果 早期感染组机械通气比例和早期手术比例显著高于非感染组（P＜0.05），两组其他感染相关因素和28 d病死率差异无统计学意义（P>0.05）。早期感染组共检出68株病原菌，分别为革兰阳性菌22株（32.4%），革兰阴性菌29株(42.6%)，真菌17株(25.0%)；早期感染组胆道感染11例（21.6%），肺部感染24例（47.1%），胰腺与胰周感染8例（15.7%），血流性感染3例（5.9%），创面感染7例（13.7%），尿路感染4例（7.8%）。结论 FAP患者早期感染发生率较高，机械通气和早期手术可能与早期感染的发生相关；革兰阴性菌为主要病原菌，革兰阳性菌和真菌也占据一定比例。

关键词: 重症急性胰腺炎, 暴发性急性胰腺炎, 感染, 病原菌

Abstract:

Objective To investigate clinical and bacteriological characteristics of early infections in patients with fulminant acute pancreatitis (FAP). Methods Eighty-two patients with FAP hospitalized in surgical intensive care unit were selected, and were classified into early infection group (with infection in 14 d from the disease onset, n=51) and non-infection group (without infection in 14 d from disease onset, n=31). The clinical data including infection related factors and 28 d mortality were compared between groups. And characteristics of infections and bacteriological characteristics of patients in early infection group were analyzed. Results The proportions of mechanical ventilation and surgical intervention in early infection group were significantly higher than those in non-infection group (P＜0.05). However, there was no significant difference in the other infection related factors and 28 d mortality between the two groups (P>0.05). In early infection group, 68 pathogens were isolated, which were 22 strains (32.4%) of gram positive bacteria, 29 strains (42.6%) of gram negative bacteria, and 17 strains (25.0%) of fungus. There were 11 cases (21.6%) of cholangitis, 24 cases (47.1%) of pneumonia, 8 cases (15.7%) of peri-pancreatic infection, 3 cases (5.9%) of bloodstream infection, 7 cases (13.7%) of wound infection, and 4 cases (7.8%) of urinary tract infection in early infection group. Conclusion The prevalence of early infection is high in patients with FAP, which may be related to mechanical ventilation and early surgical intervention. The main pathogen is gram negative bacteria, while gram positive bacteria and fungi also take an important part.

Key words: severe acute pancretitis, fulminant acute pancreatitis, infection, pathogen