经直肠前列腺穿刺活检术后败血症的相关因素分析  

Bacteria Sepsis Following Puncture of Prostate via Rectum

作　　者：李卫平[1] 郭秀全[2] 王养民[1] 张斌[1] 宋灵敏[1] 

机构地区：[1]兰州军区兰州总医院泌尿外科,甘肃兰州730050 [2]兰州大学第二临床医学院泌尿外科,甘肃兰州730000

出　　处：《现代生物医学进展》2015年第11期2098-2101,共4页Progress in Modern Biomedicine

摘　　要：目的:虽然前列腺穿刺活检术前预防及术后治疗都有了很大的创新,但术后的并发症仍可能发生,本文通过对前列腺穿刺术后感染性并发症的前瞻性检测,对其致病菌进行描述,探讨经直肠前列腺穿刺活检术后败血症的发生率、致病菌、发病相关因素,为临床上败血症的治疗和预防提供理论依据。方法:对2008年1月-2012年11月在兰州军区总医院经直肠前列腺穿刺活检术后238例患者中6例尿路败血症患者进行回顾性分析及术后随访。结果:经直肠前列腺穿刺活检术后并发败血症占2.52%(6/238),8例败血症患者中感染性休克患者3例。血培养阳性6例,5例为大肠埃希菌,1例为耐甲氧西林金葡菌。结论:经直肠前列腺穿刺是简单有效的活检方式,但仍有发生败血症的可能,致病菌多为大肠埃希菌。术前适当准备及术后合理预防可减少并发症的发生。如患者前列腺穿刺活检术后48 h内出现败血症的症状,则应立即入院给予碳青霉烯类治疗。多重耐药大肠埃希菌感染要引起足够重视,早期的直肠及尿液耐药大肠埃希菌检查可有助于败血症的早期预防。Objective： Despite the recent innovations of preoperative prevention and postoperative treatment, complications of prostate biopsy can occur. The aim of this study was a prospective monitoring of major septic complications occurring after transrectal prostate biopsy, to describe their causing agents, to explore the incidence, relative factors and management of the infectious after the procedure of diagnostic puncture of prostate via rectum, and to give guidelines based on ours personal experiences for clinical treatment and prevention. Methods： The infectious of 238 patients who underwent prostate biopsy via rectum were studied between 2008.1 and2012.11 retrospectively. Results： Among the 238 patients, septic shock was found in 6 cases（2.52%）, blood culture positive in 6 patients,Escherichia coli in 5 patients and Methicillin-resistant staphylococcus aureus（MRSA）in 1 patient. Of the 10 patients, one died after the onset of multiorgan failure. For the other five, the mean time spent in the hospital was 9 days（range, 6-15 days）. Conclusion： Though puncture of prostate via rectum is considered simple and safe, bacteria sepsis may happen during the application, pathogenic bacteria is Escherichia coli mostly, If a patient who has recently undergone transrectal prostate biopsy shows clinical signs of sepsis in the 48 h, The patient must be admitted urgently to the hospital and carbapenem antibiotic therapy should be started. In the process of treatment the drug resistance of E. coli should arouse our enough attention, a multiresistant E. coli infection must be suspected. Early recognition of patients who harbor MDRO E. coli in their rectum or in the urine could be an important strategy for preventing sepsis.

关 键 词：败血症 前列腺穿刺活检 感染 

分 类 号：R697.3[医药卫生—泌尿科学] R737.5[医药卫生—外科学]