急性梗阻性化脓性胆管炎合并感染性休克患者的临床特征及治疗后相关指标变化  

Clinical characteristics of acute obstructive suppurative cholangitis patients complicated with septic shock and treatment outcomes

作　　者：周渠新 朱剑南 金凯 杨晓峰 谢雪峰 

机构地区：[1]永嘉县人民医院外科,浙江温州325100

出　　处：《中华医院感染学杂志》2018年第1期88-91,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(30500473)

摘　　要：目的探究急性梗阻性化脓性胆管炎合并感染性休克患者的临床特征和治疗后转归。方法选取2015年3月-2016年10月期间医院收治的63例急性梗阻性化脓性胆管炎患者作为本研究试验对象,给予抗感染抗休克等对症治疗后,实施手术,观察并记录患者手术情况,术后并发症情况,分析比较治疗前后心功能、肝肾功能相关指标变化情况。结果 63例患者中,术后发生切口感染2例,感染率3.17%,胆总管结石残留患者1例,残留率1.59%,2例合并多器官衰竭,占3.17%;2例出现胆瘘,占3.17%,死亡3例,病死率4.76%;总并发症发生率为15.87%。患者治疗后平均动脉压较治疗前显著升高,而心率较治疗前显著降低,治疗前后差异有统计学意义(P<0.05);患者治疗后肝功能指标丙氨酸氨基转移酶、天冬氨酸转氨酶和直接胆红素较治疗前明显降低,而胆碱酯酶和白蛋白含量较治疗前显著上升,治疗前后差异有统计学意义(P<0.05);肾功能指标血清尿素氮和血肌酐均较治疗前有明显下降(P<0.05)。结论急性梗阻性化脓性胆管炎合并感染性休克患者均伴有发热、腹痛、意识模糊、心率加快、血压降低、尿量减少、炎症反应加重等多器官受损症状;给予抗感染、抗休克、补充血容量,补充水电解质,纠正酸中毒以及手术治疗后,感染症状得到有效控制,肝肾器官受损现象也得到改善,疗效较好,并发症较少,有利于预后。OBJECTIVE To explore the clinical characteristics of acute obstructive suppurative cholangitis patients complicated with septic shock and investigate the treatment outcomes.METHODS A total of 63 patients with acute obstructive suppurative cholangitis who were treated in the hospital from Mar 2015 to Oct 2016 were recruited as the study objects and given symptomatic therapies such as anti-infection and antishock therapies and then received surgical procedures.The status of operation and incidence of postoperative complications were observed, and the cardiac function, liver function and renal function indexes were compared before and after the treatment.RESULTS Of the 63 patients, 2 had postoperative incision infections, with the infection rate 3.17 % there were 1 （1.59 %） case of residual common bile duct stones, 2 （3.17%） cases of complication with multiple organ failure and 2 （3.17%） cases of biliary fistula, and 3 patients died, with the mortality rate 4.76%.The total incidence rate of complications was 15.87%.The mean arterial pressure of the patients was increased more significantly after the treatment than before the treatment, while the heart rate of the patients was decreased more significantly after the treatment than before the treatment（P 〈0.05）.The levels of liver function indexes alanine aminotransferase, as- partate transaminase and direct bilirubin of the patients were reduced more significantly after the treatment thanbefore the treatment, however, the levels of cholinesterase and albumin of the patients were elevated more signifi- cantly after the treatment than before the treatment（P〈0.05）.The levels of renal function indexes serum urea ni- trogen and serum creatinine of the patients were reduced more significantly after the treatment than before the treatment （P〈0.05）.CONCLUSION The acute obstructive suppurative cholangitis patients complicated with septic shock are complicated with fever, abdominal pain, clouding of consciousness, rapid heart rate, reduction of blo

关 键 词：急性梗阻性化脓性胆管炎 感染性休克 临床特征 治疗 

分 类 号：R657.45[医药卫生—外科学]