医学综述
醫學綜述
의학종술
MEDICAL RECAPITULATE
2015年
11期
2107-2108,2109
,共3页
恶性梗阻黄疸%胆管感染%经皮穿刺肝胆管引流
噁性梗阻黃疸%膽管感染%經皮穿刺肝膽管引流
악성경조황달%담관감염%경피천자간담관인류
Malignant obstructive jaundice%Biliary tract infection%Percutaneous transhepatic cholang-ial drainage
目的：分析恶性梗阻性黄疸患者经皮穿刺肝胆管引流（ PTCD）术后胆管感染的危险因素，并探讨预防措施。方法选择2011年1月至2013年1月在大连市友谊医院接受诊治的恶性梗阻性黄疸患者75例，分析行PTCD术后胆管感染病原菌的分布及构成情况，并对其危险因素进行筛选分析。结果本组75例患者中，19例患者发生胆管感染，感染率为25.3％。采集标本并培养159株，阳性标本为81株，其中革兰阳性菌12株，占14.8％；革兰阴性菌69株，占85.2％。革兰阳性菌主要以粪肠球菌（8.6％）及鸟肠球菌（4.9％）为主；革兰阴性菌以大肠埃希菌（48.1％）及克雷伯菌（24.7％）为主。多因素Logistic回归分析结果显示，梗阻位置时间（ OR ＝14.261，95％CI 5.281～31.862）、出现胆管再狭窄（OR ＝3.862，95％CI 5.281～31.862）、外引流管留置时间（OR ＝9.137，95％CI 1.469～15.957）是PTCD术后胆管感染的危险因素（ P＜0.05）。结论 PTCD术后胆管细菌感染为其常见并发症，梗阻位置、胆管再狭窄及外引流管留置时间为 PTCD 术后胆管感染的危险因素，采取有效预防措施可降低PTCD术后胆管感染的发生。
目的：分析噁性梗阻性黃疸患者經皮穿刺肝膽管引流（ PTCD）術後膽管感染的危險因素，併探討預防措施。方法選擇2011年1月至2013年1月在大連市友誼醫院接受診治的噁性梗阻性黃疸患者75例，分析行PTCD術後膽管感染病原菌的分佈及構成情況，併對其危險因素進行篩選分析。結果本組75例患者中，19例患者髮生膽管感染，感染率為25.3％。採集標本併培養159株，暘性標本為81株，其中革蘭暘性菌12株，佔14.8％；革蘭陰性菌69株，佔85.2％。革蘭暘性菌主要以糞腸毬菌（8.6％）及鳥腸毬菌（4.9％）為主；革蘭陰性菌以大腸埃希菌（48.1％）及剋雷伯菌（24.7％）為主。多因素Logistic迴歸分析結果顯示，梗阻位置時間（ OR ＝14.261，95％CI 5.281～31.862）、齣現膽管再狹窄（OR ＝3.862，95％CI 5.281～31.862）、外引流管留置時間（OR ＝9.137，95％CI 1.469～15.957）是PTCD術後膽管感染的危險因素（ P＜0.05）。結論 PTCD術後膽管細菌感染為其常見併髮癥，梗阻位置、膽管再狹窄及外引流管留置時間為 PTCD 術後膽管感染的危險因素，採取有效預防措施可降低PTCD術後膽管感染的髮生。
목적：분석악성경조성황달환자경피천자간담관인류（ PTCD）술후담관감염적위험인소，병탐토예방조시。방법선택2011년1월지2013년1월재대련시우의의원접수진치적악성경조성황달환자75례，분석행PTCD술후담관감염병원균적분포급구성정황，병대기위험인소진행사선분석。결과본조75례환자중，19례환자발생담관감염，감염솔위25.3％。채집표본병배양159주，양성표본위81주，기중혁란양성균12주，점14.8％；혁란음성균69주，점85.2％。혁란양성균주요이분장구균（8.6％）급조장구균（4.9％）위주；혁란음성균이대장애희균（48.1％）급극뢰백균（24.7％）위주。다인소Logistic회귀분석결과현시，경조위치시간（ OR ＝14.261，95％CI 5.281～31.862）、출현담관재협착（OR ＝3.862，95％CI 5.281～31.862）、외인류관류치시간（OR ＝9.137，95％CI 1.469～15.957）시PTCD술후담관감염적위험인소（ P＜0.05）。결론 PTCD술후담관세균감염위기상견병발증，경조위치、담관재협착급외인류관류치시간위 PTCD 술후담관감염적위험인소，채취유효예방조시가강저PTCD술후담관감염적발생。
Objective To analyze the risk factors of biliary tract infection after percutaneous transhepatic cholangial drainage(PTCD) in patients with malignant obstructive jaundice.Methods A total of 75 patients with malignant obstructive jaundice admitted in Dalian Friendship Hospital from Jan.2011 to Jan.2013 were selected,distribution and composition of pathogens of postoperative biliary tract infection after PTCD and risk factors of the infection were analyzed.Results Among 75 patients, biliary tract infections occurred in 19 patients,the infection rate was 25.3%.Specimens were collected and 159 strains of pathogens were cultured, including 81 strains of positive samples,among which there were 12 stains of gram -positive bacteria,account-ing for 14.8%;69 strains of gram-negative bacteria,accounting for 85.2%.Gram-positive bacteria mainly in-cluded Enterococcus faecalis(8.6%) and birds enterococci(4.9%);while gram-negative bacteria mainly included Escherichia coli(48.1%) and Klebsiella(24.7%).Results of multivariate logistic analysis showed that site of obstruction(OR =14.261,95%CI 5.281-31.862),bile duct restenosis(OR =3.862,95%CI 5.281-31.862),inwelling of external drainage catheter (OR=9.137,95%CI 1.469-15.957) were the risk factors of biliary tract infection after PTCD(P <0.05).Conclusion Biliary tract infection after PTCD is common complication of obstruction,site of obstruction,bile duct restenosis and indwelling time of external drainage catheter are independent risk factors for the infection ,effective preventive measures can reduce the incidence of biliary tract infection after PTCD .
