胰腺術后腹腔細菌感染病原菌特性及治療

徐云來

[摘要] 目的 探討胰腺術后腹腔細菌感染菌譜及耐藥情況，并取抗生素行針對性治療。方法 隨機選取醫院胰腺手術患者80例作為研究對象，取腹腔內引流液行細菌培養和藥敏實驗。 結果 該組80例患者中，31例出現腹腔細菌感染，占38.75%。分離出42株細菌，3株為革蘭陽性菌，占7.14%；38株為革蘭陰性菌，占91.48%，其中銅綠假單胞菌占50.0%。38例革蘭陰性菌藥實驗結果顯示，對慶大霉素、多占菌素B、阿米卡星的敏感性較高分別為70.27%、77.42%、78.95%，對頭孢唑林、頭孢吡肟、哌拉西林的敏感性較低，分別為0.0%、27.78%、28.57%。根據患者發熱情況行腹腔引流或腹腔引流聯合敏感抗生素治療均痊愈出院。 結論 胰腺術后腹腔細菌感染病以革蘭陰性菌為主，病原菌呈多重耐藥性，臨床可根據患者發熱及藥敏感實驗結果，合理取抗生素用藥，控制腹腔感染。

[關鍵詞] 胰腺手術；腹腔感染；病原菌；耐藥性

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2015）04（c）-0022-02

[Abstract] Objective To investigate the bacterial spectrum and drug resistance of bacteria with abdominal infection after pancreatic surgery， and to take antibiotics for targeted therapy. Methods Selected 80 patients with pancreatic surgery in our hospital as the research object， took drainage for bacterial culture and drug sensitive test in abdominal cavity. Results 80 patients in this group， 31 cases with abdominal cavity bacterial infection， accounted for 38.75%. 42 bacterial strains were isolated， 3 cases were gram positive bacteria， accounting for 7.14%； 38 strains were gram negative bacilli， accounting for 91.48%， among which of pseudomonas aeruginosa accounted for 50%. 38 cases of gram negative bacteria medicine experimental results showed higher sensitivity to gentamicin， accounted for by actinomycin B， Amikacin was respectively 70.27%， 77.42%， 78.95%， with lower sensitivity to cefazolin， cefepime， piperacillin， were respectively 0%， 27.78%， 28.57%. According to the situation of patients with fever for peritoneal drainage or peritoneal drainage combined with sensitive antibiotics were cured. Conclusion Pancreatic postoperative intraperitoneal bacterial infection with Gram negative bacteria were the main pathogens multiple drug resistance， clinical according to the patients with fever and drug sensitive test results， reasonable antibiotic drugs， and control the abdominal infection.

[Key words] Pancreatic operation； Abdominal infection； Pathogen； Drug resistance

因胰腺手術較大，部分患者術后易出現腹部感染，若治療不當，可能誘發胰瘺、術后出血、全身炎癥反應綜合癥，嚴重者還可能誘發多器官功能不全綜合征，甚至死亡，直接影響著患者的預后生活質量[1]。因此，臨床應加強對胰腺術后腹腔感染及細胞耐藥情況的分析，指導臨床合理用藥，控制疾病發展[2]。該研究分析醫院胰腺術后腹腔細菌菌譜及耐藥性，以指導臨床合理選取抗生素治療，現分析2008年9月—2013年9月間行胰腺手術患者80例的臨床資料，報道如下。

1 資料與方法

1.1 一般資料

隨機選取醫院行胰腺手術患者80例作為研究對象，其中男性43例，女性37例，年齡為19～70歲，平均（46.21±3.21）歲。……