重症急性胰腺炎合并腹腔感染的感染特点和相关因素分析

目的 探讨重症急性胰腺炎（SAP）合并腹腔感染的感染特点及其相关因素分析。方法 回顾性分析2008年1月至2015年6月我院收治的125例SAP患者的临床资料，分析腹腔感染细菌菌谱的特点及影响腹腔感染发生的危险因素。结果 125例患者中48例（38.40%）合并腹腔感染，死亡12例（9.60%）。共培养出病原菌92株，其中革兰阴性菌61株（66.30%），革兰阳性菌25株（27.17%）和真菌6株（6.52%）。单因素分析显示病因、APACHEⅡ评分、合并多器官功能障碍综合征（MODS）、外科干预及全肠外营养时间与SAP发生腹腔感染有关（P0.05）。多因素分析结果显示，APACHE Ⅱ评分≥11、合并MODS、全肠外营养时间≥1周是SAP发生腹腔感染的独立危险因素（P<0.05）。结论 SAP合并腹腔感染多为多重感染，以革兰阴性菌感染为主。APACHE Ⅱ评分≥11、合并MODS、全肠外营养时间≥1周的SAP患者，易并发腹腔感染。

The features and relevant factors of abdominal infection in patients with severe acute pancreatitis

Objective To investigate the features and risk factors of abdominal infection in patients with severe acute pancreatitis (SAP). Methods The clinical data of 125 patients with SAP admitted from Jan. 2008 to Jun. 2015 were retrospectively analyzed in regards to the features of the pathogens and related risk factors of abdominal infection. Results 48 cases (38.40%) occurred abdominal infection and 12 cases (9.60%) died. 92 strains of pathogenic bacteria were found, including 61 strains (66.30%) of Gram-negative bacteria, 25 stains (27.17%) of Gram-positive bacteria and 6 strains (6.52%) of fungi. Univariate analysis identified that the pathogeny, score of APACHE II, multiple organ dysfunction syndrome (MODS), surgical intervention and time period of total parenteral nutrition were associated with abdominal infection (P0.05). Logistic regression analysis revealed that an APACHE II score of above 11, concurrent MODS, and more than a week of total parenteral nutrition were independent risk factors for abdominal infection (P<0.05). Conclusion Concurrent abdominal infection with SAP is usually multiple infection and caused predominantly by Gram-negative bacteria. The patients having APACHE II score of above 11, concurrent MODS, or more than a week of total parenteral nutrition are susceptible to abdominal infection.