本文選題：PTCD + 膽道感染��； 參考：《青海大學(xué)》2017年碩士論文

【摘要】：目的:統(tǒng)計(jì)并分析青海大學(xué)附屬醫(yī)院所在地區(qū)因梗阻性黃疸(MOJ)行經(jīng)皮肝穿刺膽道引流術(shù)(PTCD)治療術(shù)后膽道感染患者膽汁中的主要病原菌的分布情況及其對(duì)不同抗生素的敏感情況,為本地區(qū)該類疾病臨床用藥提供指導(dǎo)。方法:1.樣本采集:a術(shù)中:患者術(shù)前嚴(yán)格消毒、鋪巾,按照PTCD常規(guī)手術(shù)流程于DSA下進(jìn)行穿刺,穿刺成功后用20ml一次性針筒連接穿刺針并抽取15-20ml標(biāo)本即刻送檢,做細(xì)菌+真菌培養(yǎng)及藥敏試驗(yàn)以備對(duì)比;b術(shù)后:對(duì)于術(shù)后出現(xiàn)感染的患者,采用20ml一次性無(wú)菌針管連接PTCD引流管,負(fù)壓抽取15-20ml膽汁樣本,并立即送檢。2.標(biāo)本培養(yǎng):膽汁采樣,立即將標(biāo)本接種至血平板,時(shí)間2h,再將血平板置于37℃恒溫箱培養(yǎng)12h-24h,分離純化標(biāo)準(zhǔn)參照衛(wèi)生部臨床檢驗(yàn)中心《檢驗(yàn)操作規(guī)程》。3.檢測(cè)方法:進(jìn)行細(xì)菌種類鑒定所需的G-菌鑒定卡GNI及G+菌鑒定卡GPI均來(lái)自法國(guó)的VITEK-32細(xì)菌自動(dòng)分析系統(tǒng);并采用VITEK-32型全自動(dòng)微生物分析儀的專用藥敏卡對(duì)病原菌的耐藥性進(jìn)行檢測(cè)。4.數(shù)據(jù)處理:運(yùn)用Excel表格建立數(shù)據(jù)庫(kù);并用世界衛(wèi)生組織推薦使用于細(xì)菌耐藥性監(jiān)測(cè)的WHONET統(tǒng)計(jì)軟件對(duì)所得結(jié)果進(jìn)行一般描述性分析。結(jié)果:(1)本試驗(yàn)共采集膽汁樣本219例,培養(yǎng)所獲得菌株數(shù)共253株,含20個(gè)種類,其中G-菌194株(76.7%),G+菌共53株(20.9%),真菌6株(2.4%);G-菌前三位分別為大腸桿菌93株(36.7%)、肺炎克雷伯桿菌39株(15.4%)、銅綠假單胞菌18株(7.1%),G+菌排名前兩位的分別為屎腸球菌17株(6.7%)、糞腸球菌14株(5.5%);真菌以白色假絲酵母菌為主,共3株(1.2%);(2)對(duì)G-菌敏感性較高的抗菌藥物包括碳青霉烯類、氨基糖苷類及頭孢類抗生素;對(duì)G+菌敏感性較高的抗菌藥物包括喹諾酮類、惡唑烷酮類及糖苷類抗生素;真菌對(duì)三唑類抗真菌藥物均保持敏感。結(jié)論:1.我院所在地區(qū)因梗阻性黃疸行PTCD治療術(shù)后膽道感染的患者膽汁中的病原菌以G-菌為主,其次為G+菌和真菌,部分病例為混合型感染。2.臨床治療該類疾病時(shí),經(jīng)驗(yàn)性用藥首選G-菌敏感的抗菌藥,對(duì)于感染程度較輕的患者,因阿米卡星腎毒性較大,應(yīng)先選用頭孢西丁和(或)哌拉西林/他唑巴坦。對(duì)于感染較重的患者選用亞胺培南,用藥3天后,如感染控制不理想,提示G+菌或合并G+菌感染的可能,此時(shí)改用或者聯(lián)合使用G+菌敏感的抗生素,如環(huán)丙沙星、利奈唑胺,病情較重的患者可選用萬(wàn)古霉素,如2周后感染仍不緩解,則考慮合并真菌感染,此時(shí)加用抗真菌藥物,如氟康唑、氟胞嘧啶、伊曲康唑或伏立康唑。
[Abstract]:Objective: to analyze the distribution of main pathogenic bacteria in bile of patients with biliary tract infection after percutaneous transhepatic biliary drainage (PTCD) for obstructive jaundice (MOJ) in the affiliated hospital of Qinghai University. To provide guidance for the clinical use of this kind of disease in this area. Method 1: 1. Sample collection: the patient was sterilized strictly before operation, laid a towel, punctured under DSA according to the routine procedure of PTCD operation. After the puncture was successful, the needle was connected with 20ml disposable syringe and the 15-20ml specimen was taken for examination immediately. Bacterial fungus culture and drug sensitivity test were used for comparison after operation: for the patients with postoperative infection, 20ml was used to connect the 15-20ml drainage tube with a single sterile needle, and the samples of 15-20ml bile were taken by negative pressure, and the samples were immediately submitted to the patients. 2. Sample culture: sample bile, immediately inoculate the sample to blood plate for 2 hours, then culture blood plate in 37 鈩，

本文編號(hào)：2091005