经口内镜下肌切开术术后一过性菌血症发生率的临床研究  

Incidences of postoperative transient bacteremia underwent peroral endoscopic myotomy: a prospective study

作　　者：王楠钧 令狐恩强[1] 翟亚奇[1] 罗燕萍[1] 王向东[1] 杜红[1] 朱静[1] 孟江云[1] 王红斌[1] 王冰[1] 邱晓珏[1] 孔金艳[1] 邰翠萍 张宝晶[1] 

机构地区：[1]中国人民解放军总医院消化科,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2013年第6期29-33,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的通过研究经口内镜下肌切开术(POEM)术后一过性菌血症的发生率,为POEM的进一步发展及推广提供理论依据。方法前瞻性地连续选择2013年6月5日至2013年9月12日在解放军总医院消化内镜中心行POEM术患者36例。术后5 min、30 min、6 h、16 h分别抽血行血培养及血常规、C反应蛋白检测,记录体温,密切监测患者术后感染相关并发症。结果 32例患者成功完成手术及抽血,其中2例患者在术后5 min、30 min血培养中分别培养出革兰阳性杆菌及凝固酶阴性葡萄球菌,但在各自的其他三个时间点的血培养均为阴性。此外,患者术后白细胞计数、中性粒细胞比例、C反应蛋白量及体温均有不同程度的升高,且以中性粒细胞的升高最为明显(P<0.001)。结论POEM术后存在一过性菌血症,但其具体发生率及最终结论尚需大样本进一步研究。Objective To investigate incidences of postoperative transient bacteremia underwent peroral endoscopic myotomy （POEM） for achalasia so that it could provide the theoretical basis for the further development and generalization of POEM. Methods We conducted a prospective study of 36 patients undergoing POEM in our digestive endoscopy center between June 5th,2013 and September 12th, 2013. Blood cultures （both aerobic and anaerobic bacteria）, blood routine, c-reactive protein and body temperature were performed and recorded 5 minutes after, 30 minutes after,6 hours after, and 16 hours after the procedure. Complications, especially infection, were given close observation. Results 32 patients were successfully completed surgery and blood drawing. Two of 32 patients （6.3%） had positive blood euhures at 5 minutes and 30 minutes after the procedure, and the isolated microorganism were gram-positive bacilli and coagulase negative staphylococcus,respectively. However, in their other time points, the blood cultures were negative. What＇s more,the white blood cell count, neutrophils ratio, c-reactive protein and temperature increased to varying degrees after the procedure,with the rise of neutrophils is most obvious （P 〈 0.001）. Conclusions Transient bacteremia associated with POEM was existent. Meantime, study on a large scale are still awaited to reach the final conclusion.

关 键 词：经口内镜下肌切开术 贲门失弛缓症 一过性菌血症 

分 类 号：R619[医药卫生—外科学]