肝硬化食管胃底静脉曲张镜下治疗后发生血流感染6例临床观察与护理

CLINICAL NURSING OF BLOODSTREAM INFECTIONS IN6 CASES OF CIRRHOSIS WITH ESOPHAGEAL AND GASTRIC VARICES AFTER ENDOSCOPIC TREATMEN

目的探讨食管胃底静脉曲张镜下治疗后发生血流感染的临床特点，用于指导临床护理。方法回顾性分析中国人民解放军总医院2011年1月-2012年12月收治的肝硬化食管胃底静脉曲张镜下治疗后发生血流感染6例患者的临床资料，分析其血培养结果及临床用药情况及护理。结果6例肝硬化食管胃底静脉曲张患者，予以胃镜下硬化剂和／或组织胶治疗，术后预防性应用抗生素（如头孢呋辛钠、头孢替安、或联合奥硝唑）抗感染治疗，术后平均3．7d（1～6d）患者出现发热，乏力，纳差等临床症状，血培养结果提示，其中阴沟肠杆菌，铜绿假单胞菌，大肠埃希菌各1例，凝固酶阴性葡萄球菌2例，肠球菌属、近平滑念珠菌和光滑念珠菌混合感染1例，根据血培养结果及药敏结果，4例给予亚胺培南／西司他丁钠、1例给予利奈唑胺、1例给予3代头孢菌素、哌拉西林／他唑巴坦抗感染治疗后，平均2．5d体温降至正常，加强护理，促进患者康复。结论临床护士应该提高对疾病的认识，对于肝硬化食管胃底静脉曲张镜下治疗后发生血流感染的患者，注意观察患者的临床表现，及时发现血流感染情况，根据药敏结果调整抗生素，早期应用，加强护理，减少患者痛苦。

Objective To study the clinical features of bloodstream infections after endoscopic treatment with esophageal and gastric varices, to guide the clinical nursing. Methods A retrospective analysis of 6 cases of bloodstream infections with liver cirrhosis and esophageal varices after endoscopic treatment in au- thor＇s hospital from 2011 to 2012 were made. The clinical features, results of blood culture and antibiotics were analyzed. Results Six cirrhotic patients with esophageal and gastric varices underwent sclerotherapy and/or endoscopic injection of tissue adhesive therapy. Prophylactic antibiotics （such as cefuroxime sodi- um, cefotiam, or combined with ornidazole） were used after the treatment. All the patients had the symp- toms of fever, fatigue, and anorexia after an average of 3.7 days post- operation. The results of blood cul- ture showed Enterobacter cloacae, Pseudomonas aeruginosa, and Escherichia coli infection in each case, co- agulase negative Staphylococcus in 2 cases, and mixed infection of Enterococcus, Candida parapsilosis and Candida glabrata in 1 case. According to the results of blood culture and drug sensitivity test, 4 patients were treated with imipenem / cilastatin sodium, one patient was treated with linezolid, and one patient was treated with the 3rd generation cephalosporins. All the patients recovered and the average temperature dropped to normal after 2.5 days. Conclusions Clinicians should raise awareness of bloodstream infections of cirrhosis with esophageal and gastric varices after endoscopic treatment, and adjust antibiotics according to the drug sensitivity test timely.