本文關(guān)鍵詞： 膽道梗阻 膽道感染 膽汁細(xì)菌培養(yǎng)　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討膽道梗阻并發(fā)膽道感染的相關(guān)因素,為膽道感染的診斷、治療及預(yù)防提供參考。方法:回顧性分析2015年9月~2016年10月于遵義醫(yī)學(xué)院附屬醫(yī)院接受PTCD/PTGD術(shù)治療的膽道梗阻患者114例,其中男65例,女49例,年齡35~91歲,平均65.57歲,術(shù)前梗阻時(shí)間平均24.51天。所有病例均行超聲、CT或MRI等影像學(xué)檢查,同時(shí)行肝功能、血常規(guī)、腫瘤抗原標(biāo)志物等實(shí)驗(yàn)室檢查,并在術(shù)中抽取膽汁行細(xì)菌培養(yǎng)。根據(jù)臨床表現(xiàn)、影像學(xué)檢查、實(shí)驗(yàn)室檢查及膽汁細(xì)菌培養(yǎng)結(jié)果診斷是否存在膽道感染。收集患者膽道梗阻相關(guān)臨床資料:性別(男、女)、年齡(≥60歲、60歲)、病因(腫瘤性、結(jié)石性)、病程時(shí)間(≥10、10天)、梗阻部位(高位梗阻、低位梗阻)、梗阻程度(完全性、不全性)、膽道手術(shù)史(有、無(wú))、肝功能Child-Pugh評(píng)分(11、≥11分)、術(shù)前堿性磷酸酶濃度(300 U/L、300-600 U/L、≥600 U/L)、膽汁細(xì)菌培養(yǎng)結(jié)果(陽(yáng)性、陰性)等10項(xiàng)指標(biāo)作為研究參數(shù)。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行分析,P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:114例膽道梗阻患者合并膽道感染67例,感染率為58.9%(67/114),共分離出微生物98株,常見(jiàn)的微生物依次為大腸埃希菌28.6%(28/98)、肺炎克雷伯桿菌12.2%(12/98)、糞腸球菌7.1%(7/98)、屎腸球菌5.1%(5/98)、陰溝腸桿菌5.1%(5/98)。膽道感染相關(guān)因素單因素分析:性別(c2=0.023,P=0.394)、年齡(c2=0.136,P=0.432)、術(shù)前堿性磷酸酶濃度(c2=5.593,P=0.054)三項(xiàng)參數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);梗阻病因(c2=18.958,P=0.000)、病程時(shí)間(c2=17.365,P=0.000)、梗阻部位(c2=4.634,P=0.026)、梗阻程度(c2=8.144,P=0.004)、膽道手術(shù)史(c2=5.530,P=0.015)、肝功能Child-Pugh評(píng)分(c2=5.955,P=0.012)、膽汁細(xì)菌培養(yǎng)陽(yáng)性(c2=6.958,P=0.009)是膽道梗阻并發(fā)膽道感染的相關(guān)因素,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中結(jié)石性梗阻、起病急、低位梗阻、不全性梗阻、有膽道手術(shù)史、肝功能Child-Pugh評(píng)分≥11分、膽汁細(xì)菌培養(yǎng)陽(yáng)性是膽道梗阻并發(fā)膽道感染的高危因素。上述高危因素采用多因素Logistic分析結(jié)果顯示結(jié)石性梗阻、有膽道手術(shù)操作史、肝功能評(píng)分≥11分、膽汁細(xì)菌培養(yǎng)陽(yáng)性是膽道梗阻并發(fā)膽道感染的獨(dú)立危險(xiǎn)因素。結(jié)論:膽道梗阻易并發(fā)膽道感染,結(jié)石性梗阻、病程時(shí)間短、低位梗阻、不全性梗阻、有膽道手術(shù)史、肝功能Child-Pugh評(píng)分≥11分、膽汁細(xì)菌培養(yǎng)陽(yáng)性是膽道梗阻并發(fā)膽道感染的高危因素;其中結(jié)石性梗阻、膽道手術(shù)史、肝功能評(píng)分高、膽汁細(xì)菌培養(yǎng)陽(yáng)性是膽道梗阻并發(fā)膽道感染的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the related factors of biliary tract infection in biliary obstruction, and to diagnose biliary tract infection. Methods: from September 2015 to October 2016, 114 patients with biliary obstruction treated with PTCD/PTGD in affiliated Hospital of Zunyi Medical College were analyzed retrospectively, including 65 males and 49 females, aged 35 to 91 years, with an average of 65.57 years old. The mean time of obstruction before operation was 24.51 days. All the patients were examined by CT or MRI, and the liver function, blood routine, tumor antigen markers and other laboratory examinations were performed simultaneously, and the bile was extracted during the operation for bacterial culture. Imaging examination, laboratory examination and bile bacterial culture were used to diagnose the presence of biliary tract infection. Clinical data related to biliary obstruction were collected: sex (male, female, age 鈮，

本文編號(hào)：1530936