| Part one.Analysis of clinical characteristics of acute pancreatitis in southern sichuanObjective:Based on acute pancreatitis(AP)large database,to analyze the clinical characteristics of AP in southern sichuan,and to provide the evidence for the clinical treatment of AP and information for AP epidemiology in southern sichuan.Methods:According to the inclusion and exclusion criteria,3190 of AP patients were included in AP database from 2013 to 2017,classified as mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP),severe acute pancreatitis(SAP)according to Atlanta classification 2012,to analyze the etiology,severity,laboratory index,mortality,hospitalization expense and other data of AP.Results:(1)AP database source:this AP database mainly come from luzhou city,yibin city,zigong city,neijiang city and other southern sichuan areas,accounting for 98.5%of AP in sichuan province,and 84.3%of the total AP.(2)Occurrence status of AP:The number of hospital admissions from 2013 to 2017 was 482 cases,563 cases,621 cases,727 cases and 797 cases respectively,showed an increasing trend year by year,and the number of MAP,MSAP and SAP was also increasing year by year.(3)Etiology of AP:Biliary AP is the most common(52.0%),followed by hypertriglyceridemic AP(24.9%),alcoholic AP(9.7%),idiopathic AP(8.4%),mixed AP(2.6%),and other AP(2.5%).There was an increasing trend of biliary AP,hypertriglyceridemic AP and alcoholic AP,while the idiopathic AP showed a decreasing trend.There were more females than males in biliary AP,especially among middle-aged and elderly women.However,there were more males than females in hypertriglyceridemic AP and alcoholic AP,hypertriglyceridemic AP is frequently found in young and middle-aged men,and alcoholic AP is frequently found in middle-aged men,the difference was statistically significant(P<0.05).(4)Analysis of severity of AP:There were1761 cases(55.2%)in MAP,807 cases(25.3%)in MSAP,and 622 cases(19.5%)in SAP among the 3190 cases of AP patients.Among them,(1)Cause:The overall distribution of severity of AP in different etiologies was statistically significant(P<0.05).The proportion of biliary AP in MAP was higher than that in MSAP,the proportion of alcoholic AP and mixed AP in MSAP was higher than that in MAP.However,there was no significant difference in the proportion of different severity of AP in hypertriglyceridemic AP,idiopathic AP and other AP,Also,there was no statistical difference between SAP and non-SAP groups in different etiologies.(1)The time of onset to admission:The time of onset to admission was most common in less than 12 hours in MAP,and were most common in more than 24 hours in both MSAP and SAP,the difference was statistically significant(P<0.05),the time of onset to admission was positively correlated with its severity(Kendall′s tau-b=0.258,P<0.05).(1)Analysis of SAP:People aged 70 and above were more common than people under 70 years old in hypertriglyceridemic SAP and alcoholic SAP,the difference were statistically significant(P<0.05).(5)Laboratory index:(1)The mean of lymphocyte number and lymphocyte rate:The mean of lymphocyte number were 1.1±0.7,1.0±0.6,0.9±0.5(×10~9/L)in MAP,MSAP and SAP respectively within 24 hours of admission,and the mean of lymphocyte rate were10.6±7.3,7.4±4.4,7.1±4.8(%)in MAP,MSAP and SAP respectively,both were negatively correlated with its severity(Kendall′s tau-b=-0.098,P<0.05;Kendall′s tau-b=-0.198,P<0.05).The mean of lymphocyte number and lymphocyte rate in infected group were 1.0±0.7(×10~9/L),8.1±6.0(%)respectively,the mean of lymphocyte number and lymphocyte rate in uninfected group were 1.2±0.6(×10~9/L),9.2±6.0(%)respectively,the former was lower than the latter,the difference was statistically significant(P<0.05),In the infected group,the mean of lymphocyte number and lymphocyte rate in mixed positions group were 0.8±0.3(×10~9/L),5.3±2.4(%)respectively,the mean of lymphocyte number and lymphocyte rate in single position group were1.0±0.6(×109/L),8.5±6.3(%)respectively,,the former was lower than the latter,and the difference was statistically significant(P<0.05).The mean of lymphocyte number of AP in different etiologies was different,the mean of lymphocyte number of hypertriglyceridemic AP was higher than that of biliary AP,idiopathic AP,and mixed AP,and the difference was statistically significant(P<0.05).However,there was no statistical difference in the average lymphocyte rate of AP in different etiologies.(1)The mean of D-dimer:The mean of D-dimer at the highest level were 2.2±2.6,4.2±3.4,7.8±5.8(mg/L)after admission in MAP,MSAP and SAP respectively,there was a positive correlation between the mean of D-dimer of AP and its severity(Kendall′s tau-b=0.491,P<0.05).The mean of D-dimer in the infected group was5.3±4.9(mg/L),while the mean of D-dimer in the uninfected group was4.2±5.0(mg/L),the former was higher than the latter,and the difference was statistically significant(P<0.05).The mean of D-dimer with AP was not related to the etiology.(6)Analysis of the prognosis of AP:In 3190 cases of AP patients,2507 cases(78.6%)were cured,504 cases(15.8%)were improved,103cases(3.2%)were unhealed,76 cases(2.4%)died,the overall mortality of AP was 2.4%,and the mortality of SAP was 12.2%.In SAP patients,the time of onset to admission was most common in less than 12 hours(53.8%)in the cured patients,the time of onset to admission was most common in more than24 hours(40.4%)in the improved patients,the time of onset to admission was most common in 12 to 24 hours(16.6%)in the unhealed patients,the time of onset to admission was most common in more than 24 hours(15.8%)in the death,and the difference was statistically significant(P<0.05).The time of onset to admission of SAP was positively correlated with its prognosis(Kendall′s tau-b=0.160,P<0.05).The etiology analysis showed that the mortality of alcoholic SAP was low,and the difference was statistically significant(P<0.05).Meanwhile,the analysis of the mortality and age of SAP showed that the mortality rate of SAP was higher in the age of 70 and above,the difference was statistically significant(P<0.05).(7)Lengh of the stay and hospitalization expense of AP:The average length of the stay of MAP,MSAP and SAP was11.1±6.5(day),15.5±6.9(day),21.7±10.7(day)respectively;The average length of the stay with mixed factors was the longest,and the alcohol factors was the shortest in AP patients with different severity,the difference was statistically significant(P<0.05);As for hospitalization expense,the average hospitalization expense of MAP,MSAP and SAP was 2.1±1.5(ten thousand yuan),3.5±3.3(ten thousand yuan)and 5.8±3.6(ten thousand yuan)respectively;The average hospitalization expense of alcohol AP was the lowest in MAP patients,the difference was statistically significant(P<0.05),while the average hospitalization expense was not related to the etiology in MSAP and SAP patients.Conclusions:(1)The main cause of AP was biliary factor in southernsichuan,Inrecentyears,theincidenceofbiliaryAP,hypertriglyceridemic AP and alcoholic AP was on the rise while idiopathic AP showed a decreasing trend.(2)Biliary AP was frequently found in elderly women,hypertriglyceridemic AP was frequently found in young and middle-aged men,and alcoholic AP was frequently found in middle-aged men in southern sichuan.(3)In non-SAP,biliary AP tended to be mild,while alcoholic AP and mixed AP tended to be serious.(4)Early admission after the onset of AP was related to milder severity,early admission after the onset of SAP was related to better prognosis.(5)In older patients(aged 70 and above),hypertriglyceridemic SAP and alcoholic SAP were more common in younger patients.(6)The mean of lymphocyte number and lymphocyte rate of AP were negatively correlated with its severity.and there was a positive correlation between the mean of D-dimer of AP and its severity.(7)The mortality of alcoholic SAP was lower,and the mortality of older SAP(aged 70and above)was higher.Part two.The distribution of pathogenic bacteria and clinical characteristics of the secondary infection of severe acute pancreatitisObjective:To explore the distribution of pathogenic bacteria and clinical characteristics of SAP secondary infection,provide reference for clinical treatment.Methods:We collected 328 samples from different parts of our hospital,which were confirmed as SAP secondary infection,and carried out the bacterial culture.The drug sensitive experiment was carried out with the automatic analyzer.to analyze the source of samples,pathogenic bacteria and its resistance to commonly used antimicrobial agents.Results:(1)Samples Source:a,source of site:A total of 156 positive specimens were obtained,with the largest number of sputum samples(46.8%);b,source of time:Samples of blood(70.6%)were collected at most within 1 week,sputum samples(64.4%)from 1 week to 2 weeks,and pancreatic necrotic tissues or peripancreatic fluid samples(51.8%)after 3 weeks,and the difference was statistically significant(P<0.05).(2)Distribution of pathogenic bacteria:156strains were isolated including 86 strains of gram-negative bacteria(55.1%),of which acinetobacter baumannii and escherichia coli were the most commonly,41 strains of gram-positive bacteria(26.3%),27 strains of fungus(18.6%).(3)Analysis of drug resistance:There is a high tolerance rate of commonly used antimicrobial agents,and the drug resistance rate of cinetobacter baumannii to carbapenems antibiotics was 88.0%.Conclusions:SAP secondary infection is mainly gram-negative bacteria,of which acinetobacter baumannii and escherichia coli were the most commonly.SAP secondary gram-negative bacterial infection can choose sulperazone,tigarocycline,and the selection of vancomycin and linnazolamide for the infection of gram-positive bacteria.There is a high proportion of multidrug-resistant bacteriaof SAP secondary infection,selecting suitable antimicrobial agents according to bacterial culture is beneficial to control infection early. |
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