肝内胆管结石患者术后感染的相关因素分析

Risk factors of postoperative infection in patients with intrahepatic bile duct stones

目的研究肝内胆管结石患者术后感染的相关因素,以降低患者感染率。方法选择2012年12月-2015年12月医院接诊的胆管结石手术患者60例进行研究,统计患者感染率、感染部位及病原菌分布,分析其引起感染的危险因素,采用SPSS18.0统计软件对数据进行统计处理。结果 60例肝内胆管结石患者术后发生感染26例,感染率为43.33%;26例患者中肺部感染9例占34.62%,切口感染6例占23.08%,肝下腹腔和膈下各感染4例,各占15.38%;感染患者中分离出44株病原菌,其中革兰阳性菌9株、革兰阴性菌30株及真菌5株,分别占20.46%、68.18%及11.36%,主要为大肠埃希菌、粪肠球菌以及肺炎克雷伯菌,分别占43.18%、9.10%及6.82%;年龄≥60岁、术前胆管炎、既往胆道手术史、合并糖尿病、手术时间、抗菌药物使用时间、术后拔除引流管时间为肝内胆管结石手术患者术后感染的危险因素(P<0.05)。结论既往的胆道手术史、术后延长拔出引流管、合并糖尿病为肝内胆管结石手术患者术后感染的危险因素,术中针对危险因素采取积极的预防措施,能够一定程度上降低患者的感染率。

OBJECTIVE To study the risk factors of postoperative infection in patients with intrahepatic bile duct stones,so as to reduce the infection rate.METHODS A total of 60 cases of bile duct stones surgery from Dec.2012 to Dec.2015 were selected.The infection rates,infection sites,and pathogen distribution were analyzed,and the risk factors were analyzed.The data were analyzed by SPSS 18.0.RESULTS Totally 26 cases of infection occurred in 60 cases after surgery,and the infection rate was 43.33%.In 26 cases of infected patients,there were9 cases of pulmonary telecasts infection,accounting for 34.62%;6cases of wound infection,accounting for23.08%;4cases of hepatic abdominal infection,accounting for 15.38%;and 4cases of subphrenic infection,accounting for 15.38%.Totally 44 strains of pathogens were isolated,including 9strains of gram-positive bacteria,30 strains of gram-negative bacteria,and 5strains of fungi,accounting for 20.46%,68.18%,and 11.36%,respectively.The pathogens were mainly Escherichia coli,Klebsiella pneumonia,and K.pneumonia,accounting for 43.18%,9.10%,and 6.82%,respectively.Age≥60,preoperative cholangitis,previous billiard surgery,diabetes,operation time,usage time of antibiotics,postoperative drainage tube pulled extend time were risk factors for postoperative infection in patients with intrahepatic bile duct stones.CONCLUSIONPrevious billiard surgery,postoperative drainage tube pulled extend,diabetes were risk factors for postoperative infection in patients with intrahepatic bile duct stones.Taking active preventive measures according to the risk factors can to some extent reduce the infection rate.