重症急性胰腺炎合并深部真菌感染的治疗经验

为分析重症急性胰腺炎(SAP)合并深部真菌感染的临床特点、危险因素及预后,并探讨其防治的策略,回顾性分析85例SAP合并感染的临床资料,其中43例合并真菌感染,42例为单纯细菌感染。研究发现2组的年龄、性别、病因、ICU住院时间均无显著性差异;真菌感染组较细菌感染组APACHE Ⅱ评分及CT分级高,发生菌群紊乱、腹压增高及器官障碍的概率高、手术次数多,且均有显著性差异。真菌组的病死率约是细菌组的2倍多(44.19％比21.43％)。结果提示:合并真菌感染病死率明显增高;APACHE Ⅱ评分、CT分级、菌群紊乱、腹压增高、手术次数是真菌感染发生的危险因素;当发现不明原因的发热、意识改变及大出血时应怀疑合并真菌感染的可能;预防性抗真菌药物的应用可能有助于防治真菌感染。

Severe Acute Pancreatitis with Fungal Infection

The objective was to analyse the clinical characteristic, risk factors and prognosis of severe acute pancreatitis (SAP) with fungal infection. Retrospective analysis of 85 cases of SAP with infection was carried out. Among them 43 cases were with fungal infection, and others with bacterial infection. There were no significant differences in age, sex, etiology between the two groups. In the fungal group, APACHE Ⅱ score, CT score, times of operation were higher than the bacterial group. Flora disorder, increased abdominal express and MODS were more often found in fungal infection cases. Mortality in fungal group was twice more than that in the bacterial group(44.19% : 21.43% ). Conclusion: Fungal infection can increase mortality of SAP. APACHE Ⅱscore, CT score, Flora disorder, increased abdominal express and times of operation are risk factors of fungal infection. Unknown fever, consciousness change and heavy bleeding may indicate fungal infection. Antifungal Prophylaxis will benefit the treatment of SAP.