【摘要】：目的：通過總結(jié)分析中南大學(xué)湘雅醫(yī)院近十年來重癥急性胰腺炎(severe acute pancreatitis, SAP)合并真菌感染的病例資料,以求進(jìn)一步提高SAP合并真菌感染的診治水平。 方法：查閱2003年01月至2012年08月在中南大學(xué)湘雅醫(yī)院普外科及中心ICU住院治療的SAP合并真菌感染病例53例�；仡櫺苑治錾鲜霾±囊话阗Y料、病因、臨床表現(xiàn)、實(shí)驗(yàn)室檢查、影像學(xué)檢查、并發(fā)癥、治療及預(yù)后情況。 結(jié)果：①一般資料：53例患者中男性32例,女性21例；發(fā)病年齡多為30-59歲,中位數(shù)年齡48.19歲。②病因：SAP病因依次為膽源性、高脂血癥、飲酒、病因不明、暴飲暴食。③住院時(shí)間：平均住院天數(shù)31.13±21.5天,42例患者住ICU,平均住ICU天數(shù)17.96±17.05天。④臨床表現(xiàn)：癥狀以不明原因發(fā)熱、腹瀉、尿急尿頻為主。⑤檢查：B超發(fā)現(xiàn)胰腺改變44例,CT發(fā)現(xiàn)胰腺改變52例,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。⑥菌譜特點(diǎn)：SAP多為混合感染,以單純真菌感染15例(28.3%),真菌合并G-性菌29例(54.71%)最常見；真菌合并G+性菌G-性菌感染9例(17%)。細(xì)菌培養(yǎng)出G-性菌77株,其中銅綠假單胞、肺炎克雷伯各20株,以肺部感染50例,胰周引流液15例多見。G+性菌16株,尿路感染、消化道感染、菌血癥、胰周感染各4例。其中金黃色葡萄球菌、屎腸球菌各6株,真菌感染以霉菌23株為主,尿路感染24例最多見。⑦抗感染治療：有43例患者有藥物利用指數(shù)(drug utilization index, DUI)大于1.0,說明實(shí)際劑量高于每日限定劑量(defined daily dose, DDD),為超劑量使用抗生素情況。其中DUI≤1患者9例,DUI=1～1.99患者29例,DUI2患者14例。未抗真菌治療組11例,死亡8例。常規(guī)治療組19例,死亡5例,預(yù)防治療組23例,死亡3例。預(yù)防治療組病死率明顯低于常規(guī)治療組,有統(tǒng)計(jì)學(xué)意義。⑧預(yù)后：APACHE Ⅱ評(píng)分0～10分患者20例,死亡1例,死亡率5%,APACHE Ⅱ評(píng)分11-20分患者25例,死亡10例,死亡率40%,APACHE Ⅱ評(píng)分21-30分患者8例,死亡5例,死亡率62.5%,不同APACHE評(píng)分等級(jí)患者死亡率差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： 1.SAP合并真菌感染多見于中老年患者,常見病因?yàn)槟懺葱�、高脂血癥。 2.SAP合并真菌感染多為混合感染,以真菌合并G-性菌感染多見。 3.SAP合并真菌感染患者大部分存在不同程度超量使用廣譜抗生素情況。 4.預(yù)防性使用抗真菌藥物可降低SAP合并真菌感染患者病死率。
[Abstract]:Aim: to summarize and analyze the data of severe acute pancreatitis (severe acute pancreatitis, SAP) complicated with fungal infection in Xiangya Hospital of Central South University in recent ten years in order to further improve the diagnosis and treatment level of SAP complicated with fungal infection. Methods: from January 2003 to August 2012, 53 cases of SAP complicated with fungal infection were hospitalized in Xiangya Hospital, Central South University, China. Methods: 53 cases of SAP complicated with fungal infection were treated in the department of general surgery and ICU of Central South University. The general data, etiology, clinical manifestations, laboratory examination, imaging examination, complications, treatment and prognosis of the above cases were retrospectively analyzed. Results: 1General data: among 53 patients, 32 were male and 21 were female; Most of the patients were 30 years old and 59 years old, and the median age was 48.19 years old. 2Etiology of SAP: biliary origin, hyperlipidemia, drinking, unknown etiology and overeating. 3 hospitalization time: the average length of hospitalization was 31.13 鹵21.5 days. The average duration of stay in ICU in 42 patients with ICU, was 17.96 鹵17.05 days. 4 Clinical manifestations: fever of unknown origin, diarrhea, frequent urination. 5 examination: 44 cases of pancreatic changes were found by B-ultrasound, 52 cases were found by CT. The difference was statistically significant (P0.05). 6 the characteristics of bacterial spectrum: most of SAP were mixed infection, 15 cases (28.3%) were simple fungal infection, 29 cases (54.71%) were fungus complicated with G-sex bacteria; There were 9 cases (17%) of fungal infection with G-sex bacteria. There were 77 strains of G-bacteria, of which 20 were Pseudomonas aeruginosa and 20 were Klebsiella pneumoniae, 50 cases were pulmonary infection, 15 cases were peri-pancreatic drainage fluid, 16 strains were G bacteria, 4 cases were urinary tract infection, 4 cases were digestive tract infection, 4 cases were bacteremia and 4 cases were peripancreatic infection. Among them, 6 strains of Staphylococcus aureus and 6 strains of Enterococcus faecium, 23 strains of fungal infection, 24 cases of urinary tract infection were the most common. 7 Anti-infective treatment: 43 cases had drug utilization index (drug utilization index, DUI) greater than 1.0, The results showed that the actual dose was higher than the daily limited dose of (defined daily dose, DDD), for the use of over-dose antibiotics. There were 9 patients with DUI 鈮，

本文編號(hào)：2464414