老年细菌性肝脓肿的临床分析

Clinical course and treatment of bacterial liver abscesses in elderly

目的 :分析老年人细菌性肝脓肿的临床特点 ,治疗方法和转归。方法 :采集1992～2001年本院全部细菌性肝脓肿70例 ,回顾性地比较中青年对照组 (60岁以下)和≥60岁的老年病人的临床要点。结果 :临床均以发热为主要症状 ,与对照组相比 ,老年组中左叶脓肿比例稍多 (30 8%比16 1% ) ,两组的脓肿最大径相似 ,患糖尿病 (41 0%比22 5% )和胆道结石 (28 2%和16 7% )等基础疾病较多。老年组的平均最高白细胞计数较高 ,血清白蛋白浓度明显较低(30 3±6 3)g/L比 (34 1±5 6)g/L。老年组有3例死亡(7 1% ) ,对照组无死亡。结论 :老年细菌性肝脓肿病人属较重的感染。老年发热病人应及早做超声和 (或)CT检查。应重视血和引流液的细菌培养 ,特别注意肺炎克雷伯菌感染 ,尽早采用有效的抗菌药物。穿刺引流是安全有效的治疗措施 ,老年人的细菌性肝脓肿预后取决于基础疾病。

Objective:To assess the clinical features,methods of treatment and outcme in elderly patients with bacterial liver abˉscess.Methods:From1991to200170patients with bacterial liver abscess were treated.These patients wee divided into2subgroups,controlled subgroup under60years old(31cases),and geriatric subgroup≥60years(39cases).The clinical characteristic,underlying diseases,methods of treatment and mortality were analyzed.Results:In comparison with the controlled subgroup,among the geriatric subgroup of patients there were more abscess in left lobe of liver,(34.8%vs16.1%),more underlying disease:diabetes mellitus(41.0%vs22.5%),and chololithiasis(28.2%vs16.7%).Lower serum albumin levels was noted in geriatric subgroup(30.3±6.3)g/L vs(34.1±5.6)g/L.The methods of treatment were similar in both groups,but the mortality of geriatric subgroup was higher(7.1%vs0%).Conclusion:Bacterial liver abscess is a serious disease in elderly.Early ultrasonography or CTis important tools for diagnosis and guiding the treatment.Klebsiella is frequent in bacterial culture analyˉsis.Besides effective antibacterial drugs,drainage with needle aspiration is safe and effective.The prognosis of geriatric patients with bacterial liver abscess is determined by underlying diseases.