感染性胰腺坏死的外科治疗与耐碳青霉烯肠杆菌感染情况分析
| 作者: |
1林嘉晏,
1申鼎成,
1黄耿文,
1曹昕彤,
1宁彩虹,
1周书毅,
1纪连栋,
1魏伟,
2刘志勇
1 中南大学湘雅医院胰胆外科，湖南 长沙 410008 2 中南大学湘雅医院重症医学科，湖南 长沙 410008 |
| 通讯: |
黄耿文
Email: gengwenhuang@qq.com |
| DOI: | 10.3978/.2018.03.012 |
| 基金: | 吴阶平医学基金会临床科研专项基金资助项目（320.6750.17518）；中南大学湘雅医院管理研究基金资助项目（2016GL12）。 |
摘要
目的：探讨感染性胰腺坏死（IPN）的外科治疗策略与耐碳青霉烯肠杆菌（CRE）感染情况。
方法：回顾2010年1月—2017年9月间中南大学湘雅医院胰胆外科收治的118例IPN患者资料，并重点对CRE感染的病例进行分析。
结果：全组118例IPN患者（3例未行外科治疗）外科干预总次数为328次，平均2.77次/例，病死率20.3%（24/118），其中出现血流感染的患者的病死率明显高于非血流感染患者[（39.5%（17/43）vs. 9.0%（7/75），P<0.001]。31例（26.3%）CRE感染的IPN患者外科干预总次数为100次，平均3.22次/例，其中27例采取升阶梯治疗策略，4例采取降阶梯治疗策略，病死率为32.3%（10/31）。与较非CRE感染的IPN患者比较，CRE感染的IPN患者急性胰腺炎严重程度升高、病死率增加、ICU住院时间延长（均P<0.05）。此外，8年间IPN患者病死率逐渐下降，但CRE感染的比例近4年明显升高。
结论：IPN目前仍主要依靠外科治疗；CRE感染已成为IPN的主流病原菌，且与危重症的病死率密切相关；升阶梯治疗策略正成为CRE感染IPN的主流外科治疗策略。
关键词：
胰腺炎，急性坏死性；耐碳青霉烯肠杆菌；感染
方法：回顾2010年1月—2017年9月间中南大学湘雅医院胰胆外科收治的118例IPN患者资料，并重点对CRE感染的病例进行分析。
结果：全组118例IPN患者（3例未行外科治疗）外科干预总次数为328次，平均2.77次/例，病死率20.3%（24/118），其中出现血流感染的患者的病死率明显高于非血流感染患者[（39.5%（17/43）vs. 9.0%（7/75），P<0.001]。31例（26.3%）CRE感染的IPN患者外科干预总次数为100次，平均3.22次/例，其中27例采取升阶梯治疗策略，4例采取降阶梯治疗策略，病死率为32.3%（10/31）。与较非CRE感染的IPN患者比较，CRE感染的IPN患者急性胰腺炎严重程度升高、病死率增加、ICU住院时间延长（均P<0.05）。此外，8年间IPN患者病死率逐渐下降，但CRE感染的比例近4年明显升高。
结论：IPN目前仍主要依靠外科治疗；CRE感染已成为IPN的主流病原菌，且与危重症的病死率密切相关；升阶梯治疗策略正成为CRE感染IPN的主流外科治疗策略。
Analysis of surgical treatment of infected pancreatic necrosis and situations of carbapenem-resistant enterobacteriaceae infection
CorrespondingAuthor:Gengwen HUANG Email: gengwenhuang@qq.com
Abstract
Objective: To investigate the surgical treatment strategies for infected pancreatic necrosis (IPN) and the situations of carbapenem-resistant enterobacteriaceae (CRE) infection.
Methods: The clinical data of 118 IPN patients treated the Department of Biliopancreatic Surgery of Xiangya Hospital, Central South University from January 2010 to September 2017 were reviewed, and the cases with CRE infection was critically analyzed.
Results: In the entire group of 118 IPN patients (3 cases did not undergo surgical treatment), the number of total surgical interventions was 328 times, with an average of 2.77 times per case, and the mortality rate was 20.3% (24/118), in which, the mortality rate in patients with bloodstream infection was significantly higher than in those without bloodstream infection [(39.5% (17/43) vs. 9.0% (7/75), P<0.001]. In the 31 cases (26.3%) with CRE infection, the number of total surgical interventions was 100 times, with an average of 3.22 times per case, of whom, 27 cases underwent a step-up approach treatment, and 4 cases underwent a step-down approach treatment, with a mortality rate of 32.3% (10/31). In IPN patients with CRE infection compared with IPN patients without CRE infection, the severity of acute pancreatitis was upgraded, mortality rate was increased, and length of ICU stay was prolonged significantly (all P<0.05). In addition, the mortality rate of IPN patients was gradually reduced over the past 8 years, but the proportion of CRE infection was markedly elevated during the past 4 years.
Conclusion: IPN mainly depends on surgical treatment at present. CRE have become the main pathogenic bacteria of IPN, and are also associated with more severe conditions and longer the ICU stay. Step-up approach is becoming the mainstream surgical strategy for IPN associated with CRE.
Keywords：
Pancreatitis
Acute Necrotizing; Carbapenem-Resistant Enterobacteriaceae; Infection
Methods: The clinical data of 118 IPN patients treated the Department of Biliopancreatic Surgery of Xiangya Hospital, Central South University from January 2010 to September 2017 were reviewed, and the cases with CRE infection was critically analyzed.
Results: In the entire group of 118 IPN patients (3 cases did not undergo surgical treatment), the number of total surgical interventions was 328 times, with an average of 2.77 times per case, and the mortality rate was 20.3% (24/118), in which, the mortality rate in patients with bloodstream infection was significantly higher than in those without bloodstream infection [(39.5% (17/43) vs. 9.0% (7/75), P<0.001]. In the 31 cases (26.3%) with CRE infection, the number of total surgical interventions was 100 times, with an average of 3.22 times per case, of whom, 27 cases underwent a step-up approach treatment, and 4 cases underwent a step-down approach treatment, with a mortality rate of 32.3% (10/31). In IPN patients with CRE infection compared with IPN patients without CRE infection, the severity of acute pancreatitis was upgraded, mortality rate was increased, and length of ICU stay was prolonged significantly (all P<0.05). In addition, the mortality rate of IPN patients was gradually reduced over the past 8 years, but the proportion of CRE infection was markedly elevated during the past 4 years.
Conclusion: IPN mainly depends on surgical treatment at present. CRE have become the main pathogenic bacteria of IPN, and are also associated with more severe conditions and longer the ICU stay. Step-up approach is becoming the mainstream surgical strategy for IPN associated with CRE.