胆道梗阻患者行十二指肠镜逆行胰胆管造影术后感染因素分析

Incidence of infections in biliary obstruction patients after duodenal endoscopic retrograde cholangiopancreatography

目的调查高、低位胆道梗阻患者行十二指肠镜逆行胰胆管造影(ERCP)术后的感染率,有针对性地采取护理措施,以便更好地控制术后感染。方法回顾性分析2009年3月-2012年5月在绍兴文理学院附属医院及绍兴市人民医院行ERCP治疗高、低位胆道梗阻患者各80例,通过术后患者体温、白细胞计数及腹痛等统计分析术后感染率的发生情况。结果 ERCP术后高位胆道梗阻患者并发胰腺炎4例占5.00%、胆道感染8例占10.00%、上消化道出血1例占1.25%;低位胆道梗阻患者并发胰腺炎3例占3.75%、胆道感染3例占3.75%、上消化道出血1例占1.25%,无其他并发症出现,未出现与ERCP术相关的死亡病例,另外5例术后出现一过性高淀粉酶血症,但无腹痛;高位胆道梗阻患者术后发胆道感染10.00%,低位胆道梗阻为3.75%,两者差异有统计学意义(P<0.05)。结论高位梗阻患者行ERCP术后发生胆道感染高于低位胆道梗阻患者,提示高位胆管梗阻患者行ERCP术后更易发生感染,因此,术前术后应做好积极的护理措施以有效预防感染的发生。

OBJECTIVE To investigate the infection rates of patients with high and low biliary obstruction after duodenal endoscopic retrograde cholangiopancreatography （ERCP） so as to take targeted nursing interventions to better control the infections. METHODS A retrospective analysis was performed for the infection rates of the patients with high （80 cases ） or low （80 cases） biliary obstruction who underwent ERCP in the Affiliated Hospital of Shaoxing University or the Shaoxing Peoplers Hospital from Mar to May 2012, and the incidence of postoperative infections was statistically analyzed through the observation of postoperative body temperature, white blood cell count and abdominal pain. RESULTS After the ERCP,there were 4 （5.0%） cases of patients with high biliary obstruction complicated with pancreatitis, 8 （10.0 %） cases with biliary tract infections, 1 （1.25 %） case with upper gastrointestinal bleeding; while there were 3 （3. 75%） cases of patients with low biliary obstruction complicated with pancreatitis, 3 （3.75 %） cases with biliary tract infections, and 1 （l. 25 %） case with upper gastrointestinal bleeding, no other complications occurred, nor the death cases related to the ERCP, in addition, transient hyperamylasemia occurred in 5 patients without stomach ache. The incidence rate of biliary tract infections was 10.0% of the patients with high biliary obstruction and 3.75% of the patients with low biliary obstruction after the ERCP, the difference between the two was statistically significant （P〈0.05） . CONCLUSION The incidence rate of the biliary tract infections is higher in the patients with high biliary obstruction than in the patients with low biliary obstruction after the ERCP, which indicates that the patients with high biliary obstruction after ERCP are more susceptible to the infections, therefore , it is necessary to take active nursing measures so as to effectively prevent the infections.