急性重症胰腺炎患者腹腔感染的临床诊断及治疗  

Clinical diagnosis and treatment of severe acute pancreatitis patients complicated with abdominal infections

作　　者：杨科[1] 杨启[1] 秦长岭[1] 

机构地区：[1]南阳市中心医院肝脏普外科,河南南阳473003

出　　处：《中华医院感染学杂志》2015年第5期1122-1124,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅基金资助项目(HW-2010B-034)

摘　　要：目的探讨急性重症胰腺炎患者并发腹腔感染的临床诊断方法,统计常见病原菌及抗菌药物敏感性,为临床诊治急性重症胰腺炎提供参考。方法选取2009年4月-2013年10月急性重症胰腺炎并腹腔感染的患者79例,对其临床表现进行回顾性分析,并行病原菌培养和抗菌药物敏感性分析。结果 79例患者共检出病原菌84株,以革兰阴性菌最为首,检出65株占77.38%,以大肠埃希菌和肺炎克雷伯菌检出率最高,分别占39.29%和17.86%;革兰阳性菌检出16株占19.05%,其中葡萄球菌属占10.71%,真菌检出率最低,占3.57%;革兰阴性菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/舒巴坦最为敏感,敏感率分别为100.00%、89.23%和80.00%,而对氨苄西林敏感性较低,仅18.46%;革兰阳性菌对万古霉素、利奈唑胺表现出了高度的敏感,敏感率达100.00%,对青霉素敏感率最低,仅为31.25%。结论急性重症胰腺炎并发感染者多有典型的临床表现,在确诊之后应及时给予抗菌药物经验性治疗,并及时进行病原菌培养和药敏试验,待结果报告后及时调整用药。OBJECTIVE To explore the measures for clinical diagnosis and treatment of the severe acute pancreatitis patients complicated with abdominal infections and observe the distribution and drug susceptibility of common pathogens so as to provide guidance for clinical diagnosis and treatment of severe acute pancreatitis .METHODS A total of 79 severe acute pancreatitis patients complicated with abdominal infections who were treated from Apr 2009 to Oct 2013 were enrolled in the study ,the clinical manifestations of the participants were retrospectively an‐alyzed ,and the culture of pathogens and the drug susceptibility testing were performed .RESULTS Totally 84 strains of pathogens have been isolated ,including 65 （77 .38% ） strains of gram‐negative bacteria ,16 （19 .05% ） strains of gram‐positive bacteria ,and the fungi （3 .57% ）;the Escherichia coli and K lebsiella pneumoniae were the predominant gram‐negative bacteria isolated ,accounting for 39 .29% and 17 .86% ,respectively ;the Staphy‐lococcus spp was dominant among the gram‐positive bacteria ,accounting for 10 .71% .The drug susceptibility rates of the gram‐negative bacteria to imipenem , cefoperazone‐sulbactam , and piperacillin‐tazobactam were 100 .00% ,89 .23% ,and 80 .00% ,respectively ,and the drug susceptibility rate to ampicillin was 18 .46% ;the drug susceptibility rates of the gram‐positive bacteria to vancomycin and linezolid were as high as 100 .00% ,and the drug susceptibility rate to penicillin was the lowest （31 .25% ） .CONCLUSION The clinical manifestations of the severe acute pancreatitis patients complicated with infections are typical ,and it is necessary to conduct empirical drug therapy as soon as the patients are diagnosed ,perform the culture of pathogens and the drug susceptibility testing in a timely manner ,and adjust the medication on the basis of the results of drug susceptibility testing .

关 键 词：急性重症胰腺炎 腹腔感染 诊断 病原菌 抗菌药物 

分 类 号：R576[医药卫生—消化系统]