胰腺癌伴梗阻性黄疸患者胆道感染高危因素分析

Risk factors for biliary tract infections in pancreatic cancer patients with obstructive jaundice

目的分析胰腺癌伴梗阻性黄疸患者胆道感染分离菌及其高危因素。方法回顾性分析65例胰腺癌伴梗阻性黄疸患者术中胆汁细菌培养及药敏结果,同时对患者年龄、胆道手术史、黄疸时间、CA199、胰头肿瘤大小、胆道梗阻部位、APACHEⅡ评分等因素与胆道感染的相关性进行研究。结果胰腺癌梗阻性黄疸患者胆汁细菌培养阳性率为38.5%,其中肠杆菌科等革兰阴性菌占72.4%,对多数抗菌药物敏感;年龄>60岁、既往胆道手术史、胆道梗阻部位和APACHEⅡ评分为5～8分,是上述患者胆道感染独立危险因素。结论胰腺癌伴梗阻性黄疸患者胆汁培养以革兰阴性菌为主;高龄、既往有胆道手术史、胆道下段梗阻以及APACHEⅡ评分≥4分是胆道感染的独立危险因素,围手术期护理需特别关注。

OBJECTIVE To investigate the risk factors and causative organisms in biliary tract infections in the pancreatic cancer patients with obstructive jaundice. METHODS Data of 65 patients were retrospectively studied. Culture and antibiotic resistance results were collected from the microbiology database. Associations between risk factors for biliary tract infection and variables such as age, previous biliary tract operation history, duration of jaundice , CA199, the size of pancreatic tumor and APACHEⅡscore were analyzed. RESULTS Cultures in bile were positive in 38.5% of cases. Gram-negative bacilli （72.4%） such as Enterobacteriaceae were most commonly recovered. Four independent risk factors of biliary tract infection were identified： age, previous history of biliary tract operation, site of biliary obstruction and APACHE Ⅱ score. CONCLUSION Gram-negative bacilli were the most common organisms recovered from the bile in pancreatic cancer patients with obstructive jaundice. Age, previous biliary tract operation history, site of biliary obstruction and APACHE Ⅱ score are the independent risk factors. Special care should be attended to perioperative nursing.