内镜下黏膜剥离术后菌血症及内毒素血症的临床研究

Clinical Research of Bacteremia and Endotoxaemia after Endoscopic Submucosal Dissection

目的分析内镜下粘膜剥离术后患者发生菌血症及内毒素血症的情况,探讨预防性使用抗生素的必要性。方法选取102例行胃部内镜下粘膜剥离术的患者,于患者术前、术后立即、术后2d进行细菌血培养及血清内毒素检测,并在术后第2d检测白细胞计数以及C反应蛋白。结果 2例血培养结果出现阳性,采样时间点分别为术后立即、术后2d,培养出的细菌分别为丙酸杆菌属及产气肠杆菌,血培养阳性的2例患者未出现血流感染的临床症状;29%的患者C反应蛋白在术后2d高于1.0mg/L,且术后立即、术后2d的内毒素水平与术后2d的C反应蛋白水平具有相关性。结论内镜下粘膜剥离术后患者发生菌血症的风险较低,术后发生的白细胞计数、C反应蛋白升高与手术引起的内毒素血症有关。常规ESD术前预防性使用抗生素非必需。

Objective To explore the occurrence of bacteremia and endotoxaemia after endoscopic submucosal dissection （ESD） and to discuss the necessity of prophylactic application of antibiotics. Methods 102 cases of gastric ESD were selected and blood bacterial culture and serum endotoxin detection were made before operation, immediately after operation and on the second day after opera- tion; the leukocyte count and C-reactive protein （CRP） were detected on the second day after operation. Results The blood culture of 2 cases turned out to be positive; the sample taking was made immediately after operation and on the second day after operation; the bacteria were propionibacterium and enterobacter aerogenes; no clinical symptoms of bloodstream infection were found in these 2 cases; the CRP levels in 29% of the cases were higher than 1.0mg/L on the second day after operation, and there existed a correlation between the levels of endotoxin immediately after operation and on the second day after operation and the level of CRP on the second day after oper- ation. Conclusions The risk of bacteremia occurrence after ESD is low and the increase of leukocyte count and the CRP level are related to the occurrence of endotoxaemia caused by the operation, and it is unnecessary to make prophylactic application of antibiotics conventionally.