急性重症胰腺炎并发腹腔感染者的临床表现与治疗
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摘要
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.
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.
引文
[1]曾繁林,林洁,谢雨林,等.腹腔穿刺引流疗法治疗伴有腹腔积液重症急性胰腺炎的临床观察[J].当代医学,2017,23(25):132-134.
[2]马克强,高春江,汪志强,等.早期经口进食进行肠内营养在治疗急性重症胰腺炎中的作用[J].重庆医学,2015,44(7):965-967.
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[4]纪宗淑,耿小平,罗晓明,等.急性重症胰腺炎继发腹腔感染的临床分析[J].肝胆外科杂志,2016,14(3):166-168.
[5]韩艳艳,丁雅芳,王晓锋,等.双歧杆菌活菌片预防急性重症胰腺炎腹腔感染的观察[J].国际医药卫生导报,2015,21(9):1307-1309.
[6] Buddingh KT, Koudstaal LG, VanSantvoort HC, et al.Early angiopoietin-2 levels after onset predict the advent of severe pancreatitis, multiple organ failure, and infectious complications in patients with acute pancreatitis[J]. Journal of the American College of Surgeons, 2016,218(1):26-32.
[7]朱维铭,黎介寿.急性重症胰腺炎肠源性感染的发病机制及防治[J].医学研究生学报,2017,13(3):185-189.
[8]黄智,张兆红.腹腔灌洗结合地塞米松静滴治疗急性重症胰腺炎的临床疗效[J].四川医学,2015,12(3):365-367.
[9] Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure:a case for revising the Atlanta classification to include ‘moderately severe acute pancreatitis’[J]. Gastroenterology, 2017, 104(3):710-715.
[10]高兰花,邓冬英,李玉岩,等.腹腔灌洗治疗重症急性胰腺炎合并腹腔感染的护理[J].中国医药科学,2016,2(18):165,167.
[11]杨科,杨启,秦长岭,等.急性重症胰腺炎患者腹腔感染的临床诊断及治疗[J].中华医院感染学杂志,2015(5):1122-1124.
[12] Luan ZG, Zhang J, Yin XH, et al. Ethyl pyruvate significantly inhibits tumour necrosis factor-α, interleukin-1βand high mobility group box 1 releasing and attenuates sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury[J]. Clinical and Experimental Immunology,2016,172(3):417-426.
[13]徐静敏.探讨ICU优质护理干预措施在行床旁血液滤过急性重症胰腺炎(SAP)患者中的应用价值[J].中国医药指南,2016,14(35):218-219.
[14]邓杰.腹腔镜下腹腔灌洗引流术治疗重症胰腺炎的临床效果分析[J].当代医学,2017,23(20):103-104.
[15] Tao Jing, Wang Chunyou, Chen Libo, et al. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome[J]. Medical sciences, 2015,23(4):399-402.
[16]骆雪萍,叶宁,夏炳杰.重症急性胰腺炎合并呼吸衰竭患者腹腔感染危险因素及病原菌分析[J].中国全科医学,2016,14(21):2395-2397.
[17]邢彦峰,尚冰.重症急性胰腺炎并发腹腔感染的相关危险因素及病原菌[J].贵州医科大学学报,2018,43(3):353-356,361.
[2]马克强,高春江,汪志强,等.早期经口进食进行肠内营养在治疗急性重症胰腺炎中的作用[J].重庆医学,2015,44(7):965-967.
[3] Azadani A, Jonsson H, Park P. A randomized trial comparing rates of abdominal contamination and postoperative infection among natural orifice transluminal endoscopic surgery, laparoscopic surgery, and open surgery in pigs[J]. Gastrointestinal Endoscopy, 2015,75(4):849-855.
[4]纪宗淑,耿小平,罗晓明,等.急性重症胰腺炎继发腹腔感染的临床分析[J].肝胆外科杂志,2016,14(3):166-168.
[5]韩艳艳,丁雅芳,王晓锋,等.双歧杆菌活菌片预防急性重症胰腺炎腹腔感染的观察[J].国际医药卫生导报,2015,21(9):1307-1309.
[6] Buddingh KT, Koudstaal LG, VanSantvoort HC, et al.Early angiopoietin-2 levels after onset predict the advent of severe pancreatitis, multiple organ failure, and infectious complications in patients with acute pancreatitis[J]. Journal of the American College of Surgeons, 2016,218(1):26-32.
[7]朱维铭,黎介寿.急性重症胰腺炎肠源性感染的发病机制及防治[J].医学研究生学报,2017,13(3):185-189.
[8]黄智,张兆红.腹腔灌洗结合地塞米松静滴治疗急性重症胰腺炎的临床疗效[J].四川医学,2015,12(3):365-367.
[9] Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure:a case for revising the Atlanta classification to include ‘moderately severe acute pancreatitis’[J]. Gastroenterology, 2017, 104(3):710-715.
[10]高兰花,邓冬英,李玉岩,等.腹腔灌洗治疗重症急性胰腺炎合并腹腔感染的护理[J].中国医药科学,2016,2(18):165,167.
[11]杨科,杨启,秦长岭,等.急性重症胰腺炎患者腹腔感染的临床诊断及治疗[J].中华医院感染学杂志,2015(5):1122-1124.
[12] Luan ZG, Zhang J, Yin XH, et al. Ethyl pyruvate significantly inhibits tumour necrosis factor-α, interleukin-1βand high mobility group box 1 releasing and attenuates sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury[J]. Clinical and Experimental Immunology,2016,172(3):417-426.
[13]徐静敏.探讨ICU优质护理干预措施在行床旁血液滤过急性重症胰腺炎(SAP)患者中的应用价值[J].中国医药指南,2016,14(35):218-219.
[14]邓杰.腹腔镜下腹腔灌洗引流术治疗重症胰腺炎的临床效果分析[J].当代医学,2017,23(20):103-104.
[15] Tao Jing, Wang Chunyou, Chen Libo, et al. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome[J]. Medical sciences, 2015,23(4):399-402.
[16]骆雪萍,叶宁,夏炳杰.重症急性胰腺炎合并呼吸衰竭患者腹腔感染危险因素及病原菌分析[J].中国全科医学,2016,14(21):2395-2397.
[17]邢彦峰,尚冰.重症急性胰腺炎并发腹腔感染的相关危险因素及病原菌[J].贵州医科大学学报,2018,43(3):353-356,361.