重症急性胰腺炎多重耐药菌铜绿假单胞菌感染的危险因素分析

摘要

Objective To analyze the risk factors of Pseudomonas aeruginosa (PAE) infection in severe acute pancreatitis (SAP) patients. Methods Totally 102 patients diagnosed with SAP from January 2006 to December 2016 in our hospital were retrospectively reviewed. And the patients were divided into infection group (17 cases) and control group (85 cases) according to whether or not they were complicated with PAE infection. Risk factors of PAE infection were analyzed through logistic regression analysis. Results The propor-tion of PAE infection in the SAP patients in our hospital was 16.67%. There was no significant difference in gender, etiology or complication between the two groups (P>0.05). However, compared with the control group, the infection group showed older age, higher CT severity index (CTSI) and SAP severity grading, higher inci-dences of ARDS and shock, higher APACHE Ⅱ score and longer ICU stay (P<0.05). Multivariate logistic regression analysis revealed that the risk factors of PAE infection included higher CTSI and APACHE Ⅱscore, higher SAP severity, ARDS occurrence in the acute phase, and prolonged ICU and hospital stay (P<0.05). In the aspect of clinical outcomes, the infection group showed higher incidences of shock and sepsis, longer ICU stay and total hospital stay than the control group (P<0.05); however, no significant difference was found in mortality between the two groups (P>0.05). Conclusions Risk factors of PAE infection include higher CTSI, higher SAP severity, occurrence of ARDS in the acute phase, prolonged ICU and hospital stay, and higher APACHE Ⅱ score at admission.%目的 探讨重症急性胰腺炎(SAP)患者并发多重耐药性铜绿假单胞菌(PAE)感染的危险因素及其耐药性分析.方法 回顾性纳入该院2006年1月-2016年12月收治的SAP患者102例.根据是否合并多重耐药性PAE感染分为感染组(17例)和对照组(85例),分析两组患者一般情况,采用Logistic回归分析患者感染多重耐药性PAE的危险因素.结果 SAP合并多重耐药性PAE感染的比例为16.67%.两组患者性别、病因及合并疾病发生率比较,差异无统计学意义(P>0.05).感染组年龄、CT危重度评分(CTSI)及SAP危重度分级高于对照组(P<0.05);急性期急性呼吸窘迫综合征(ARDS)和休克发生率高于对照组(P<0.05);入院时急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)评分更高;急性期重症监护病房(ICU)住院天数更长.多因素Logistic回归分析发现,PAE感染的危险因素包括CTSI、SAP危重度、急性期出现ARDS、入院APACHEⅡ评分过高及急性期过长的ICU暴露时间(P<0.05).临床预后方面,相比于对照组,感染组感染期休克和脓毒症发生率高于对照组;ICU住院天数和总住院天数高于对照组,但两组死亡率比较差异无统计学意义.结论 SAP患者PAE感染的危险因素包括CTSI、SAP危重度、急性期ARDS、过长的ICU暴露时间及入院APACHEⅡ评分过高.