重症急性胰腺炎合并真菌感染的诊断和治疗

目的 由于重症急性胰腺炎病程迁延，常存在免疫和代谢功能紊乱，真菌感染成为突出的临床问题。方法 总结１９７４年８月至１９９７年１２月收治的３５２例重症急性胰腺炎，并作真菌感染的菌谱调查。诊断主要依据临床症状和细菌学证据两方面。预防措施包括早期应用肠道营养和预防性应用抗真菌药物氟康唑。治疗包括早期应用氟康唑或两性霉素Ｂ抗真菌治疗和及时的病灶清除手术。结果 ３５２例中，７３例非手术治疗，治愈率为９０．４

Diagnosis and prophylaxis of fungi infection in severe acute pancreatitis.

Objective Fungi infection is a dominant clinical problem owing to inmunological and metabolically dysfunction during the complicated course of severe acute pancreatitis.Methods 352 cases of severe acute pancreatitis from Aug.1974 to Dec.1997 were analyzed ,and fungi infection was investigated.Diagnosis was based on clinical manifestation and positive finding of fungi from specimen.Diflucan and amphotericin B were applied once diagnosis was established.Meanwhile proper and prompt debridement,early enteral nutritional support and prophylatic administration of antifungi drugs were applied.Results Among 352 cases of severe acute pancreatitis,73 cases by nonoperative therapy with the survival rate of 90\^4%,279 cases by operation with the survival rate of 71\^3%.Among 88 cases investigated for fungi infection,49 cases were positive,with the rate of 55\^6%,in which candida infection covers 91\^4%.Early enteral nutritional support and prophylactic administration of antifungi drugs were effective to prevent fungi infection.Early application of Diflucan and Amphotericin B and proper and prompt debridement were effective to control fungi infection.Conclusion The combination of proper and prompt debridement,early enteral nutritional support,and prophylactic administration of antifungi drugs could minimize the hazard of fungi infection in severe acute necrotizing pancreatitis.Better treatment effect of fungi infection could be expected from early diagnosis and early antifungi therapy.