【摘要】：目的： 分析我院TACE術(shù)及TIPS術(shù)在圍手術(shù)期應(yīng)用抗生素對術(shù)后感染的預(yù)防價值。 方法： 收集于2007年1月至2013年3月在重慶醫(yī)科大學(xué)附屬第二醫(yī)院住院且行肝動脈化療栓塞術(shù)（transcatheter arterial chemoembolization，TACE）的肝癌患者資料以及2011年1月至2013年3月行頸靜脈肝內(nèi)門體分流術(shù)(transjugular intrahepatic portosystemic shunt，TIPS)的肝硬化患者資料。根據(jù)TACE和TIPS圍手術(shù)期是否預(yù)防性應(yīng)用抗生素，將病例分為預(yù)防性使用抗生素組和未預(yù)防性使用抗生素組，比較兩組術(shù)后感染率，并分析術(shù)后感染相關(guān)危險因素。 結(jié)果： 1.納入TACE術(shù)共計538例，包括男501例，女37例，TIPS術(shù)共計61例，包括男47例，女14例。TACE術(shù)預(yù)防性使用抗生素組術(shù)后感染率為16.7%（60/359），未預(yù)防性使用抗生素組術(shù)后感染率為20.1%(36/179), P=0.33。 2.TACE術(shù)未預(yù)防性使用抗生素組與預(yù)防性使用抗生素組在術(shù)后呼吸道感染、不明原因感染、腹膜炎、泌尿系感染、敗血癥、膽道感染、肝膿腫、胸膜炎、消化道感染的發(fā)生率差異無統(tǒng)計學(xué)意義，P0.05。 3.單因素及多因素分析提示肝功能Child-Pugh分級、手術(shù)時間大于2h為TACE術(shù)后感染的獨立影響因素。 4.TIPS術(shù)預(yù)防性使用抗生素組術(shù)后感染率為33.3%(5/15)，未預(yù)防性使用抗生素組術(shù)后感染率為34.8%(16/46)，P=0.92。 5.TIPS術(shù)后呼吸道感染、泌尿系感染、敗血癥、不明原因感染的發(fā)生率差異無統(tǒng)計學(xué)意義，P0.05。 6.多因素分析提示年齡、肝功能Child-Pugh分級為TIPS術(shù)后感染的獨立影響因素。 結(jié)論： 肝功能Child-Pugh chlid A級患者TACE術(shù)及TIPS術(shù)圍手術(shù)期不必常規(guī)預(yù)防性使用抗生素，，對于肝功能差、手術(shù)時間長、老年等高危感染因素患者，酌情選擇適宜的抗生素更有臨床預(yù)防價值。
[Abstract]:Objective: to analyze the value of TACE and TIPS in preventing postoperative infection. Methods: (transcatheter arterial chemoembolization, was collected from January 2007 to March 2013 in the second affiliated Hospital of Chongqing Medical University and performed transcatheter arterial chemoembolization (transcatheter arterial chemoembolization,). (TACE) and cirrhosis patients undergoing intrahepatic jugular portosystemic shunt (transjugular intrahepatic portosystemic shunt,TIPS) from January 2011 to March 2013. According to the prophylactic use of antibiotics in the perioperative period of TACE and TIPS, the patients were divided into two groups: prophylactic use of antibiotics and non-prophylactic use of antibiotics. The postoperative infection rate was compared between the two groups, and the risk factors of postoperative infection were analyzed. Results: 1. A total of 538 cases were included in TACE procedure, including 501 males, 37 females and 61 TIPS patients, including 47 males and 14 females. The infection rate was 16.7% (60 / 359) in the TACE group. The postoperative infection rate was 20.1% (36 / 179) in the non-prophylactic antibiotic group and 0.33% in the control group. Postoperative respiratory tract infection, unknown cause infection, peritonitis, urinary tract infection, septicemia, biliary tract infection, liver abscess, pleurisy, There was no significant difference in the incidence of digestive tract infection (P 0.05). 3. Univariate and multivariate analysis suggested that Child-Pugh grade of liver function and operation time more than 2 h were independent factors of infection after TACE. The postoperative infection rate was 33.3% (5 / 15) in the 4.TIPS group and 34.8% (16 / 46) in the non-prophylactic antibiotic group. There was no significant difference in the incidence of respiratory tract infection, urinary tract infection, septicemia and unknown cause infection after 5.TIPS (P 0.05). 6. Multivariate analysis showed that age and Child-Pugh grade of liver function were independent factors of infection after TIPS. Conclusion: the perioperative period of TACE and TIPS in Child-Pugh chlid A patients with liver function does not need routine prophylactic use of antibiotics. It is necessary for patients with high risk infection such as poor liver function, long operation time, old age and so on. The choice of appropriate antibiotics is more valuable for clinical prevention.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2;R735.7

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