53例重症急性胰腺炎合并真菌感染临床分析
发布时间：2019-04-24 11:39
【摘要】：目的：通过总结分析中南大学湘雅医院近十年来重症急性胰腺炎(severe acute pancreatitis, SAP)合并真菌感染的病例资料,以求进一步提高SAP合并真菌感染的诊治水平。 方法：查阅2003年01月至2012年08月在中南大学湘雅医院普外科及中心ICU住院治疗的SAP合并真菌感染病例53例。回顾性分析上述病例的一般资料、病因、临床表现、实验室检查、影像学检查、并发症、治疗及预后情况。 结果：①一般资料：53例患者中男性32例,女性21例；发病年龄多为30-59岁,中位数年龄48.19岁。②病因：SAP病因依次为胆源性、高脂血症、饮酒、病因不明、暴饮暴食。③住院时间：平均住院天数31.13±21.5天,42例患者住ICU,平均住ICU天数17.96±17.05天。④临床表现：症状以不明原因发热、腹泻、尿急尿频为主。⑤检查：B超发现胰腺改变44例,CT发现胰腺改变52例,差异有统计学意义(P0.05)。⑥菌谱特点：SAP多为混合感染,以单纯真菌感染15例(28.3%),真菌合并G-性菌29例(54.71%)最常见；真菌合并G+性菌G-性菌感染9例(17%)。细菌培养出G-性菌77株,其中铜绿假单胞、肺炎克雷伯各20株,以肺部感染50例,胰周引流液15例多见。G+性菌16株,尿路感染、消化道感染、菌血症、胰周感染各4例。其中金黄色葡萄球菌、屎肠球菌各6株,真菌感染以霉菌23株为主,尿路感染24例最多见。⑦抗感染治疗：有43例患者有药物利用指数(drug utilization index, DUI)大于1.0,说明实际剂量高于每日限定剂量(defined daily dose, DDD),为超剂量使用抗生素情况。其中DUI≤1患者9例,DUI=1～1.99患者29例,DUI2患者14例。未抗真菌治疗组11例,死亡8例。常规治疗组19例,死亡5例,预防治疗组23例,死亡3例。预防治疗组病死率明显低于常规治疗组,有统计学意义。⑧预后：APACHE Ⅱ评分0～10分患者20例,死亡1例,死亡率5%,APACHE Ⅱ评分11-20分患者25例,死亡10例,死亡率40%,APACHE Ⅱ评分21-30分患者8例,死亡5例,死亡率62.5%,不同APACHE评分等级患者死亡率差异有统计学意义(P0.05)。 结论： 1.SAP合并真菌感染多见于中老年患者,常见病因为胆源性、高脂血症。 2.SAP合并真菌感染多为混合感染,以真菌合并G-性菌感染多见。 3.SAP合并真菌感染患者大部分存在不同程度超量使用广谱抗生素情况。 4.预防性使用抗真菌药物可降低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 卤21.5 days. The average duration of stay in ICU in 42 patients with ICU, was 17.96 卤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，
本文编号：2464414
[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 卤21.5 days. The average duration of stay in ICU in 42 patients with ICU, was 17.96 卤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，
本文编号：2464414
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