胆道手术后脓毒症的危险因素分析及治疗

Risk factors of sepsis after biliary surgery and Its treatment

目的探讨胆道手术后脓毒症危险因素及诊治效果。方法回顾性分析307例胆道术后患者资料,按诊断标准和排除标准将其分为脓毒症组与非脓毒症组。比较两组在年龄、糖尿病、术前胆道感染、肿瘤、术前胆道梗阻时间>2周、入住ICU、深静脉置管、胆肠吻合术、术后早期单一脏器功能不全、术后留置T管的差异,应用单因素及非条件logistic回归分析危险因素。结果 21例脓毒症患者发病时间平均在术后(10.1±5.6)d,单因素分析显示,两组在糖尿病、肿瘤、胆肠吻合术、入住ICU、深静脉置管、术前梗阻时间>2周差异有统计学意义;logistic回归分析糖尿病、胆肠吻合术为胆道术后脓毒症发生的相关危险因素;21例脓毒症患者经及时清除或引流感染灶及针对性应用抗菌药物治疗均顺利康复。结论糖尿病、胆肠吻合术是胆道术后发生脓毒症的相关危险因素,对这类患者应尽可能避免长期滞留ICU或留置深静脉导管并采取预防脓毒症的措施,一旦发生脓毒症应及时清除或引流感染灶并针对性应用抗菌药物治疗;胆道手术后脓毒症患者预后良好。

OBJECTIVE To explore the risk factors and therapeutic result of sepsis following biliary surgical procedures. METHODS The data of 307 patients following biliary surgical procedures was observed and analyzed. We divided these patients into sepsis and non sepsis groups according to the criteria of diagnosis. Logistic multiple regression analysis was used to compare the age, infection before operation, carcinoma, diabetes mellitus, the duration of obstructive j aundice〉2W, catheter in deep vein, hospitalization in ICU, cholangiojejunostomy, single organ dysfunction and T-tube between these two groups. RESULTS There were 21 patients suffered from sepsis after biliary surgical procedures average 10.1±5.6 days ago. X^2 test showed there were significant differences in carcinoma, diabetes mellitus, the duration of obstructive jaundice 〉2W, catheter in deep vein, hospitalization in ICU, and cholangiojejunostomy between these two groups. Logistic multiple regression analysis showed that diabetes mellitus and cholangiojejunostomy affected the occurrence of sepsis following biliary surgical procedures. Therapeutic measures included prompt surgical drainage and antibiotics according to the result of hemoculture. All 21 patients with sepsis recovered smoothly. CONCLUSIONS Diabetes mellitus and cholangiojejunostomy are significantly associated with sepsis following biliary surgical procedures. For these patients we ought to avoid staying in ICU for along time and to remove catheter in deep vein. Prompt surgical drainage and antibiotics according to the result of hemoculture are necessary. The prognosis of sepsis following biliary surgical procedures is good.