经口内镜下肌切开术术后一过性菌血症的发生率  

Incidence of postoperative transient bacteremia after peroral endoscopic myotomy

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：《中华消化内镜杂志》2014年第5期257-260,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的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7月11日间行POEM患者12例。术后5min、30min、6h、16h分别抽血行血培养及血常规、C-反应蛋白检测，记录体温，同时密切监测患者术后感染相关并发症。结果除1例患者因术中出血，止血后终止手术，余11例患者成功完成手术，其中1例在术后5min血培养中培养出革兰阳性杆菌，而在随后的30min、6h、16h血培养中转为阴性；其余患者血培养均为阴性。同时，患者术后白细胞计数、中性粒细胞比例及C-反应蛋白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），而体温变化方面的差异并不显著（P〉0．05）。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 incidence of postoperative transient bacteremia after peroral endoscopic myotomy （POEM） in patients with achalasia and to explore the evidence for the further development of POEM. Methods A total of 12 patients underwent POEM in Digestive Endoscopy Center from June 5th 2013 to July 11 th 2013. Blood cultures （ both aerobic and anaerobic bacteria）, blood routine, C-reactive protein and body temperature examination were performed and recorded 5 minutes,30 minutes,6 hours, and 16 hours after the procedure. Complications concerning infection were under observation. Results Operation was terminated in one patient because of intraoperative bleeding, and operations in 11 other patients were successful. One （9. 1% ） had positive blood culture 5 minutes after the procedure. The isolated microorganism was gram-positive bacilli. All patients had negative blood cultures 30 minutes, 6 hours, and 16 hours after the procedure. Meanwhile,the white blood cell count, neutrophils ratio and C-reactive protein increased to varying degrees after the procedure, with the rise of neutrophils being the most obvious （P 〈 0. 001 ）. However, differences in temperature change were not significant （ P 〉 0. 05 ）. Conclusion Transient bacteremia associated with POEM exists. But studies on a large scale are still in need.

关 键 词：食管失弛症 菌血症 经口内镜下肌切开术 

分 类 号：R656.6[医药卫生—外科学]