CAJ | 학술논문

目的探讨口腔护理联合十二指肠冲洗在预防经内镜逆行胰胆管造影术(ERCP)术后胆道感染中的作用及机制.方法 284例ERCP诊疗患者中,96例行阿米卡星干预(阿米卡星组),95例行生理盐水干预(盐水组),93例不加干预(对照组).分别在十二指主乳头插管前、切开刀完成插管首次进入胆管时(即内镜操作初)和ERCP操作即将结束时(即内镜操作末)收集细菌标本并行细菌培养和菌落计数.统计分析3组ERCP术后胆管炎发生率以及不同检测点细菌检测结果.结果阿米卡星组、盐水组和对照组ERCP术后胆管炎发生率分别为7.3％ (7/96)、8.4％(8/95)和18.3％ (17/93),差异有统计学意义(x2=6.861,P=0.032);十二指肠主乳头插管前细菌培养阳性率分别为6.3％ (6/96)、25.3％ (24/95)和28.0％ (26/93),差异有统计学意义(x2=16.833,P=0.000);内镜操作初细菌培养阳性率分别为6.3％ (6/96)、16.8％(16/95)和24.7％ (23/93),差异有统计学意义(x2=12.206,P=0.002);内镜操作末细菌培养阳性率分别为7.3％ (7/96)、17.9％(17/95)和33.3％ (31/93),差异有统计学意义(x2=20.713,P=0.000).结论 ERCP诊疗可将肠道微生物逆行带入胆管,口腔护理联合十二指肠冲洗能减少胆管逆行微生物带人,从而能有效减少ERCP术后胆管炎的发生.
목적 탐토구강호리연합십이지장충세재예방경내경역행이담관조영술(ERCP)술후담도감염중적작용급궤제.방법 284례ERCP진료환자중,96례행아미잡성간예(아미잡성조),95례행생리염수간예(염수조),93례불가간예(대조조).분별재십이지주유두삽관전、절개도완성삽관수차진입담관시(즉내경조작초)화ERCP조작즉장결속시(즉내경조작말)수집세균표본병행세균배양화균락계수.통계분석3조ERCP술후담관염발생솔이급불동검측점세균검측결과.결과 아미잡성조、염수조화대조조ERCP술후담관염발생솔분별위7.3％ (7/96)、8.4％(8/95)화18.3％ (17/93),차이유통계학의의(x2=6.861,P=0.032);십이지장주유두삽관전세균배양양성솔분별위6.3％ (6/96)、25.3％ (24/95)화28.0％ (26/93),차이유통계학의의(x2=16.833,P=0.000);내경조작초세균배양양성솔분별위6.3％ (6/96)、16.8％(16/95)화24.7％ (23/93),차이유통계학의의(x2=12.206,P=0.002);내경조작말세균배양양성솔분별위7.3％ (7/96)、17.9％(17/95)화33.3％ (31/93),차이유통계학의의(x2=20.713,P=0.000).결론 ERCP진료가장장도미생물역행대입담관,구강호리연합십이지장충세능감소담관역행미생물대인,종이능유효감소ERCP술후담관염적발생.
Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel flushing for ERCP related cholangitis and to investigate the mechanisms.Methods A total of 284 patients who underwent ERCP were divided into the amikacin group (n =96),the saline group (n =95) and the control group (n =93).Specimens were collected before cannulation (Sample 1),the first access to the bile duct (Sample 2) and at the end of ERCP (Sample 3).All the samples underwent bacterial culture and colony counting.Incidence of ERCP related cholangitis and bacterial results were recorded.Results The incidences of ERCP related cholangitis were 7.3％ (7/96),8.4％ (8/95)and 18.3％ (17/93)in amikacin group,saline group and control group respectively,with significant differences among three groups (x2 =6.861,P =0.032).The positive rate of bacterial culture of Sample 1 in the amikacin group,saline group and control group were 6.3％ (6/96),25.3％ (24/95) and 28.0％ (26/93) (x2 =16.833,P =0.000),respectively.The positive rate of bacterial culture of Sample 2 in amikacin group,saline group and control group were 6.3％ (6/96),16.8％ (16/95) and 24.7％ (23/93)(x2 =12.206,P =0.002),respectively.The positive rate of bacterial culture of Sample 3 in amikacin group,saline group and control group were 7.3％ (7/96),17.9％ (17/95) and 33.3％ (31/93) (x2 =20.713,P =0.000),respectively.Conclusion The procedure of ERCP can bring the intestinal bacteria into the bile duct,which could be reduced by mouth care combined with intestinal and endoscopic working channel flushing.And the incidence of ERCP related cholangitis can be effectively reduced.