食管胃底静脉曲张内镜硬化剂治疗并发败血症危险因素分析

Analysis of risk factors of septicemia in esophageal and gastric varices after endoscopic injection of cyanoacrylate

目的 比较食管胃底静脉曲张活动性出血和无活动性出血患者接受内镜硬化剂治疗后发生脓毒血症的差异,并分析危险因素,为临床治疗提供参考.方法 同顾性分析2005-2009年浙江中医药大学附属第六医院245例接受内镜检查或治疗的肝硬化患者的临床资料,并将患者分为3组：组Ⅰ患者有活动性出血接受内镜硬化剂治疗止血,共87例;组Ⅱ患者接受内镜硬化剂治疗预防出血,共74例;组Ⅲ患者为接受常规内镜检查明确有无静脉曲张或有曲张静脉而不需要硬化剂治疗共84例.在内镜治疗前、后行血病原菌培养.结果 组Ⅰ患者内镜检查治疗前17例（19.5%）血液病原菌培养阳性,硬化剂治疗后5例（5.7%）血病原菌培养阳性.病原菌分别为大肠埃希菌10株,肺炎克雷伯菌5株,棒状杆菌2株.组Ⅱ血液病原菌培养阳性0例,组Ⅲ1例,病原菌为表皮葡萄球菌.所有患者均无临床感染证据.结论 食管胃底静脉曲张无出血患者接受内镜检查治疗不会增加血液感染的危险.对此类患者没有必要预防性应用抗菌药物.相反,对于食管胃底静脉曲张出血接受内镜硬化剂治疗的患者则需要常规接受抗菌药物预防感染.

Objective To compare the difference of septicemia incidence between patients with active gastric variceal bleeding and those with gastric varices but no active bleeding who underwent N-butyl-2-cyanoacrylate injection,and to analyse the risk factors to provide a basis for clinical therapy. Methods The clinical information in 245 patients with hepatic cirrhosis who were received endoscopic surveillance or treatment from 2005 to 2009 in the Sixth Hospital Affiliated to Zhejiang Chinese Medical University was conducted through a retrospective survey. Patients were categorized into three groups： group Ⅰ , patients with bleeding gastric varices who underwent cyanoacrylate injection for hemostasis （ n = 87）; group Ⅱ , patients who underwent elective cyanoacrylate injection for further obliteration of gastric varices （n = 74）; and group Ⅲ , patients with cirrhosis who underwent endoscopic surveillance for varices, and patients with gastric varices who presented for a follow-up endoscopy without a requirement for treatment （ n = 84）. Blood culture was obtained before and after endoscopy. Results Before procedures, blood cultures were positive in 17 patients （ 19.5% ）from group Ⅰ . The number of positive blood cultures in group Ⅰ after the procedure were 5 （5.7%）. The identified organisms were E. coli （ n = 10）, Klebsiella pneumoniae （ n = 5） and Coryneform bacteria （ n = 2）. No case was cultured positive in group Ⅱ . Only one case was Streptococcus epidermidis positive in group Ⅲ. No clinical evidence of infections occurred in any patient. Conclusions Elective cyanoacrylate injection for nonbleeding gastric varices is not associated with significant bacteremia or infection. For this reason, prophylactic antibiotics may not be needed in this patient group. By contrast, prophylactic antibiotics should be needed in patients with bleeding gastric varices who underwent cyanoacrylate injection.