老年急性胆道感染非手术治疗的临床分析  

Clinical analysis on non-surgical treatment for elderly patients with acute biliary tract infections

作　　者：王若梅[1] 周海燕[1] 陈小华[1] 

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广东广州510120

出　　处：《中华医院感染学杂志》2015年第3期641-643,共3页Chinese Journal of Nosocomiology

基　　金：广州市卫生局基金资助项目(GW-2010B028)

摘　　要：目的探讨老年急性胆道感染的非手术治疗方法,以提高老年急性胆道感染的治疗水平。方法选取2011年4月-2013年8月老年急性胆道感染患者224例,随机分为对照组和观察组,每组各112例,取两组患者胆汁标本行细菌培养和药物敏感试验,对照组患者单纯敏感抗菌药物治疗,观察组患者在对照组基础上给予消炎利胆片口服,对两组患者治疗效果、住院时间进行评价和统计。结果 224例患者共检出病原菌231株,其中革兰阴性菌191株占82.68%,以大肠埃希菌最为常见,革兰阳性球菌38株占16.45%,真菌2株占0.87%;革兰阴性菌对哌拉西林、环丙沙星、左氧氟沙星以及磺胺甲噁唑/甲氧苄啶敏感性较低,均<60.00%,而对阿米卡星敏感性较高,为95.81%,此外对美罗培南和头孢他啶的敏感率>80.00%;革兰阳性菌对红霉素敏感性较低为52.63%,而对替考拉定、万古霉素、氯霉素以及氨苄西林的敏感性较高,均>90.00%;观察组患者治疗效果明显优于对照组,且住院时间明显短于对照组,两组比较差异有统计学意义(P<0.05)。结论对于老年急性胆道感染患者采取非手术治疗时应根据细菌培养结果选择敏感抗菌药物,在敏感抗菌药物治疗的基础上给予中成药消炎利胆片口服,有利于提高患者的治疗效果,并缩短疗程。OBJECTIVE To investigate the non-surgical treatment for elderly patients with acute biliary tract infections, and then to improve the therapeutic effect. METHODS Totally 224 elderly patients with acute biliary tract infections during Apr. 2011 to Aug. 2013 were selected and randomly divided into two groups including the control group and the observation group, each of 112 cases. Bile samples of the two groups of patients were taken for bacterial culture and drug sensitivity analysis. The control group received single antibiotic therapy, and the observation group was treated with oral administration of Xiaoyanlidan tablets on the basis of treatment in the control group. Treatment efficacy and hospitalization time in the two groups of patients were evaluated and statistically analyzed. RESULTS Totally 231 pathogens were detected in the 224 patients, including 191 gram- negative bacteria accounting for 82. 68% with Escherichia coli the most prevalent, 38 gram-positive cocci accounting for 16.45%, 2 fungi accounting for 0.87%. Gram-negative bacteria had low sensitivity of 〈60.00% to piperacillin, ciprofloxacin, levofloxacin and sulfamethoxazole/trimethoprim, and high sensitivity of 95.81% to amikacin, in addition, the sensitivity to meropenem and ceftazidime was also more than 80.00%. Gram-positive bacteria had relatively low sensitivity of 52.63 % to erythromycin, while relatively high sensitivity of 〉90.00 % to teicoplanin, vancomycin, chloramphenicol, and ampicillin. Treatment efficacy was better in the observation group than in the control group, and the hospital stay was significantly shorter than in the control group （P〈0.05）. CONCLUSION For elderly patients with acute biliary tract infection, sensitive antimicrobial drugs should be chosen based on bacterial culture results for non-surgical treatment, and the oral administration of Chinese medicine Xiaoyanlidan tablets should be given on the basis of sensitive antibiotic therapy so as to improve patient outcomes and reduce treatment courses.

关 键 词：老年 急性胆道感染 抗菌药物 治疗 

分 类 号：R575.7[医药卫生—消化系统]