预防性抗真菌治疗对结直肠穿孔所致粪性腹膜炎预后的影响  

Effect of prophylactic antifungal therapy on the prognosis of stercoral peritonitis caused by colorectal perforation

作　　者：陈晓迎[1] 亢胜男 王凤林 周梧霜 彭艳[1] Chen Xiao-ying;Kang Sheng-nan;Wang Feng-lin;Zhou Wu-shuang;Peng Yan(The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院,重庆400016

出　　处：《中国急救医学》2022年第5期426-430,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨结直肠穿孔的病原学分布和预防性抗真菌治疗的有效性。方法对2015年1月至2021年12月在重庆医科大学附属第一医院诊断为结直肠穿孔所致粪性腹膜炎的患者进行回顾性观察研究,分析病原学分布,并根据48 h内是否进行预防性抗真菌治疗分为抗真菌组(n=23)和非抗真菌组(n=31),比较两组感染指标变化趋势以及预后的差异。结果①共54例结直肠穿孔患者被纳入,入院时出现脓毒症并发症40例(74.10%),感染性休克26例(48.15%),30 d病死率为33.33%。②49例患者进行了术中腹腔积液的细菌培养,38例培养结果为阳性,最多见的病原菌为大肠埃希菌35例(92.11%),且主要为产超广谱β-内酰胺酶的大肠埃希菌22例(57.89%);真菌培养阳性5例(9.26%),主要为白色念珠菌。③抗真菌组和非抗真菌组在第1、3和5天的降钙素原(PCT)、血白细胞计数(WBC)和序贯器官衰竭评分(SOFA)的动态变化及Kaplan-Meier生存分析差异均无统计学意义(P均>0.05)。结论结直肠穿孔病死率较高,产超广谱β-内酰胺酶的大肠埃希菌是其腹腔感染的主要致病菌,而真菌检出率较低,预防性抗真菌治疗未能改善预后。Objective To investigate the etiological distribution of colorectal perforation and the effectiveness of prophylactic antifungal therapy.Methods A retrospective observational study was performed in the patients with fecal peritonitis caused by colorectal perforation between January 2015 and December 2021 in our hospital.Bacterial culture was used to analyze the etiological distribution and the patients were grouped according to whether prophylactic antifungal therapy was carried out within 48 hours,the changing trend of infection indexes and the difference of prognosis were compared between the antifungal group(n=23)and the non-antifungal group(n=31).Results①A total of 54 patients with colorectal perforation were enrolled,there were 40 cases(74.10%)of septic complications and 26 cases(48.15%)of septic shock in the patients with colorectal perforation on admission,and the 30-day mortality was 33.33%.②Abdominal fluid was taken for the bacterial culture of intraoperative ascites in 49 cases,38 of which were positive.Escherichia coli were found in 35 cases(92.11%),including mainly 22 cases(57.89%)of extended-spectrumβ-lactamase-producing Escherichia coli;the positive rate of fungal culture was low(5 cases,9.26%),most of which were Candida albicans.③There was no significant difference in the dynamic changes of procalcitonin(PCT),white blood cell(WBC),SOFA score and Kaplan-Meier survival analysis between the antifungal group and the non-antifungal group on 1 d,3 d and 5 d(P>0.05).Conclusions Colorectal perforation had a higher mortality,and extended-spectrumβ-lactamase-producing Escherichia coli was the main pathogenic bacteria responsible for intra-abdominal infections caused by colorectal perforation,while the detection rate of fungi was low.Prophylactic antifungal therapy failed to improve the prognosis.

关 键 词：结直肠穿孔 病原菌 腹腔感染 真菌 

分 类 号：R656.1[医药卫生—急诊医学]