内镜下行鼻胆管引流治疗急性重症梗阻性化脓性胆管炎并胆汁细菌培养及药敏分析  

Analysis on bile bacterial culture and sensitivity under endoscopic nasal biliary drainage in the treatment of severe acute obstructive suppurative cholangitis

作　　者：蒋朝阳[1] 黄明海[2] 杨征波[1] 段振兴[1] 常健源[1] 张展[1] 何富刚[1] 张先[1] 

机构地区：[1]湖南怀化市第一人民医院重症医学科,湖南怀化418000 [2]湖南怀化市第一人民医院消化内科,湖南怀化418000

出　　处：《中国内镜杂志》2013年第12期1272-1275,共4页China Journal of Endoscopy

摘　　要：目的总结经内镜鼻胆管引流术(ENBD)治疗急性重症化脓性梗阻性胆管炎的经验,并了解该类患者胆汁细菌情况,为抗生素选择提供指导。方法在X线监视下,无痛内镜下置入鼻胆管,抽取胆汁行细菌培养及药敏分析,胆道冲洗后予ENBD处理。结果 63例患者中52例ENBD成功,其机体情况明显改善,其中死亡9例;ENBD失败11例中病情进一步恶化,其中死亡9例。52份标本中有50例培养出细菌,阳性检出率为96.2%;共培养出细菌56株,有6例检出2种细菌。革兰阴性杆菌37株,占66.1%,革兰阳性菌18株,占32.1%,真菌1株,占1.8%。G-菌组敏感率依次降低为亚胺培南、美洛培南、头孢哌酮舒巴坦、阿米卡星、头孢他啶、庆大霉素和头孢吡肟等;G+菌组敏感率依次降低为万古霉素、磷霉素、氯霉素、利福平、庆大霉素和氨苄西林等。结论内镜下行鼻胆管引流,胆道减压引流疗效可靠,能迅速有效改善患者全身状况,为进一步治疗创造条件,同时行胆汁细菌培养及药敏,可指导合理选用抗生素,减少耐药,能有效降低死亡率。【Objective】To summarize the experience of endoscopic nasal biliary drainage（ENBD） on treatment of severe acute obstructive suppurative cholangitis, and to detect these patients＇ bile＇s bacterium and provide guidance for the choice of antibiotics. 【Methods】Bile bacterial culture and sensitivity analysis were made merging painless nasobiliary endoscopic under X-ray monitoring, then biliary flush and ENBD were underwent.【Results】Of all 63 patients, 52 cases ENBD succeeded who had obvious improvement, and nine cases died; Of 11 failure cases ENBD eventually nine cases died. 52 specimens were cultured of bacterial in 50 cases, positive rate was 96.2%;Cultured 56 bacteria, there were two kinds of bacteria detected in six cases. Gram-negative bacilli 37, accounted for66.1%; Gram-positive bacteria 18, accounting for 32.1%; Fungi 1, accounting for 1.8%. The sensitive rate to Gbacteria group decreased for imipenem, meropenem, cefoperazone sulbactam, amikacin, ceftazidime, gentamicin and cefepime etc; While the sensitive rate to G＋ bacteria group decreased for vancomycin, fosfomycin, chloramphenicol,rifampin, gentamicin, ampicillin etc. 【Conclusion】The method of endoscopic nasal biliary drainage and biliary decompression is effective and reliable. It can quickly and effectively improve the general condition of the patient,creating conditions for further treatment. And simultaneously bile bacterial culture and sensitivity were made based on these results. It can guide the rational use of antibiotics and effectively reduce mortality rate.

关 键 词：内镜鼻胆管引流术 梗阻性化脓性胆管炎 胆汁 细菌培养 药敏 死亡率 

分 类 号：R657.45[医药卫生—外科学]