肝硬化门静脉高压伴上消化道出血患者胃冠状静脉栓塞联合TIPs术后感染相关因素分析

Related factors analysis of postoperative infection after gastric coronary vein embolization combined with TIPs in patients with portal hypertension of cirrhosis with upper gastrointestinal hemorrhage

[目的]探讨肝硬化门静脉高压伴上消化道出血患者胃冠状静脉栓塞联合经颈静脉肝内门体静脉分流术(TIPs)术后感染相关因素。[方法]回顾性分析214例住院的肝硬化门静脉高压伴上消化道出血患者的临床资料。采用单因素及多因素Logistic回归分析患者行胃冠状静脉栓塞联合TIPs术后发生感染的相关因素。[结果]214例患者中有17例发生了术后感染,感染发生率为7.94%。单因素分析发现年龄、术后Child-pugh评分、合并腹水、术后再出血、血清白蛋白、术后门静脉内径及脾静脉内径与术后感染的发生明显相关(P<0.05);而性别、肝硬化病因、合并基础疾病、预防性应用抗生素与术后感染的发生无关(P>0.05)。多因素分析显示,年龄>60岁、合并腹水、术后Child-pugh评分、再出血、血清白蛋白水平及脾静脉内径与感染发生率显著相关(P<0.05),是肝硬化门静脉高压伴上消化道出血患者术后发生感染的独立影响因素。[结论]肝硬化门静脉高压伴上消化道出血患者胃冠状静脉栓塞联合TIPs术后感染的危险因素较多,年龄>60岁、合并腹水、术后Child-pugh评分、再出血、血清白蛋白水平及脾静脉内径是诱导其发生的独立危险因素,应针对性制定治疗方案和预防措施,以减少术后感染的发生。

[Objective]To investigate the related factors of postoperative infection in patients with cirrhotic portal hypertension and upper gastrointestinal bleeding after gastric coronary vein embolization combined with transjugular intrahepatic portosystemic shunt(TIPs).[Methods]Clinical data of cirrhotic portal hypertension patients with upper gastrointestinal hemorrhage were retrospectively analyzed.Single and multivariate Logistic regression were used to analyze the related factors of infection after gastric coronary vein embolization combined with TIPs.[Results]Among the 214 patients,17 had postoperative infection,and the incidence of infection was 7.94%.Single analysis showed that age,postoperative Child-pugh score,ascites,postoperative rebleeding,serum albumin,postoperative portal vein diameter and splenic vein diameter were significantly correlated with postoperative infection(P<0.05).However,gender,etiology of cirrhosis,underlying diseases and prophylactic use of antibiotics were not correlated with postoperative infection(P>0.05).Multivariate analysis showed that age higher than 60 years,ascites,postoperative child-pugh score,rebleeding,serum albumin level and splenic vein diameter were significantly correlated with the incidence of infection(P<0.05),which were independent influencing factors for postoperative infection in patients with cirrhotic portal hypertension and upper gastrointestinal bleeding.[Conclusion]More risk factors for postoperative infection were found in patients with cirrhotic portal hypertension and upper gastrointestinal bleeding after gastric coronary vein embolization combined with TIPs.Age>60 years old,ascites,postoperative Child-pugh score and rebleeding,serum albumin level and spleen vein diameter were independent risk factors of infection.Treatment and prevention should be targeted to reduce the postoperative infection.