胰十二指肠切除术后超疗程使用质子泵抑制剂致感染性并发症的风险因素分析

Extended use of proton pump inhibitor after pancreaticoduodenectomy:A risk factor for infectious complications

目的探讨胰十二指肠切除术后不同用药方案对患者感染并发症发生的危险因素。方法针对胰十二指肠切除术患者进行回顾性研究。收集共150名患者围术期的药物治疗方案及相关临床数据进行多因素分析,寻找术后感染性并发症发生的独立危险因素。结果共65名患者发生了感染性并发症,胰十二指肠切除术后感染性并发症的发生与是否发生胰瘘、术中胆汁培养阳性以及超疗程使用质子泵抑制剂有关。发生胰瘘的患者较未发生胰瘘患者感染风险高3.51倍(OR=4.51,95%CI:1.54~13.18,P=0.006);术中胆汁培养阳性的患者术后感染风险增加2.76倍(OR=3.76,95%CI:1.71~8.23,P=0.001)。而超疗程使用质子泵抑制剂的46例患者中有30(65.2%)例发生感染性并发症,超疗程使用质子泵抑制剂使得感染风险上升1.58倍(OR=2.58,95%CI:1.15~5.82,P=0.020),但是消化道出血的风险和正常使用组比较差异无统计学意义(1.0%vs 2.2%,P=0.55)。结论质子泵抑制剂在胰十二指肠切除术后的超疗程使用可能增加感染性并发症发生的风险。

Objective To determine the risk factors for infectious complications after pancreaticoduodenectomy.Methods A retrospective study was performed on patients who received pancreaticoduodenectomy.The perioperative medication therapy plans and clinical data of 150 patients were collected for multivariable analysis to determine independent risk factors for infectious complications.Results Totally 65 patients had post-operative infections.Three independent risk factors were identified:pancreatic fistula(OR=4.51,95%CI:1.54-13.18,P=0.006),positive bile culture during operation(OR=3.76,95%CI:1.71-8.23,P=0.001)and extended use of proton pump inhibitor(OR=2.58,95%CI:1.15-5.82,P=0.020).Thirty of 46 patients had infectious complications after the pancreaticoduodenectomy.Extended use of proton pump inhibitor increased the risk of infec-tious complications by 1.58 times,while the risk of gastrointestinal bleeding has no statistical difference(1.0%vs 2.2%,P=0.55)compared with the normal group.Conclusion Extended use of proton pump inhibitor is a risk factor for infectious complications after the pancreaticoduodenectomy.