碳青霉烯类抗生素预防重症急性胰腺炎感染的研究  

Study on carbapenem in preventing infection of severe acute pancreatitis

作　　者：李磊[1] 刘一云[1] 张如愿[1] 汤耀卿[1] LI Lei;LIU Yiyun;ZHANG Ruyuan;TANG Yaoqing(Department of Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院重症医学科,上海200025

出　　处：《外科理论与实践》2021年第4期348-352,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:分析和探讨重症急性胰腺炎(severe acute pancreatitis,SAP)病人预防性抗生素应用的疗效及其影响因素。方法:选择2011年10月至2016年10月期间我院ICU收治的SAP病人139例,剔除收治入科时已存在感染者,选取应用碳青霉烯类抗生素的病人。最终纳入回顾性研究48例。分为发病72 h内应用组34例和72 h后应用组14例,分别预防性应用碳青霉烯类。分析SAP病人预防性抗生素应用的启动时机与预后的关系。结果:两组病人在ICU内死亡率、胰腺感染和胰外感染发生率、脏器功能衰竭持续时间、ICU住院时间差异均无统计学意义。单因素分析发现,72 h内应用病人的胰腺感染发生率与疾病严重程度(APACHEⅡ评分和SOFA评分)及胰腺病变程度(CT严重程度指数)有关,即评分越高,病人早期预防性抗生素应用失败率越高,而与病人的性别、年龄、胰腺炎病因无关。多因素分析未发现早期预防性抗生素应用失败的影响因素。结论:本研究中,早期即发病72 h内碳青霉烯类预防性抗生素应用方案不能降低SAP病人的ICU内死亡率、胰腺感染发生率和ICU住院时间。对于疾病严重程度高及胰腺坏死严重的病人,需制定个体化治疗方案。Objective To analyze the effects of prophylactic antibiotics on the patients with severe acute pancreatitis(SAP).Methods A total of 139 patients with SAP at Department of Critical Care Medicine,Ruijin Hospital from October2011 to October 2016 were selected.Forty-eight patients using carbapenem antibiotics were included in this retrospective study after patients with infection of SAP at admission were excluded.Carbapenems were used prophylactically in two groups which included 34 cases in the group used antibiotics within 72 hours onset and 14 cases in the group used after72 hours onset.The relationship between the time using antibiotic during 72 hours of SAP onset or after 72 hours and prognosis of pancreatic infection in patients with SAP was analyzed.Results There were no statistical differences in mortality at ICU,incidences of both pancreatic infection and extrapancreatic infections,duration of organ failure,and the length of ICU stays between two groups.It was indicated by univariate analysis that the higher incidence of pancreatic in-fection in patients with early prophylactic antibiotic treatment was related to the higher severity of disease including APACHEⅡscore,SOFA score and the higher degree of pancreatic lesions as CT severity index indicated.It was not re-lated to gender,age,and the etiology of pancreatitis.However,there was no factor affected the failure of early prophylactic antibiotic treatment(carbapenem)identified by multivariate analysis.Conclusions It was not shown in this study early prophylactic antibiotic treatment within 72 hours onset can reduce ICU mortality,the incidence of pancreatic infection,and the length of ICU stays in the patients with SAP.For patients with higher severity and higher severe pancreatic lesions,individualized treatment protocols need to be developed.

关 键 词：重症急性胰腺炎 预防性抗生素应用 碳青霉烯类 胰腺感染 

分 类 号：R576[医药卫生—消化系统]