肝破裂患者急救手术后腹腔感染病原菌及其影响因素  

Analysis of pathogenic bacteria and influencing factors of abdominal infection in patients with liver rupture after emergency operation

作　　者：韩雪迎[1] 张晶晶[2] 陈培莉[3] 张俊霞[1] 杨洋[1] 胡慧 HAN Xue-ying;ZHANG Jing-jing;CHEN Pei-li;ZHANG Jun-xia;YANG Yang;HU Hui(Shangqiu first peopled Hospital,Shangqiu,Henan 476100,China;不详)

机构地区：[1]商丘市第一人民医院急诊科,河南商丘476100 [2]商丘市第一人民医院胃肠肝胆一病区,河南商丘476100 [3]商丘市第一人民医院重症医学科,河南商丘476100 [4]商丘市中心医院急诊科,河南商丘476100

出　　处：《中华医院感染学杂志》2020年第19期2986-2989,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关基金资助项目(201702150)。

摘　　要：目的探究肝破裂患者急救手术后腹腔感染病原菌及其影响因素。方法选取2017年3月-2019年9月于商丘市第一人民医院就诊的肝破裂并接受急救手术的患者129例为研究对象,收集患者年龄、性别及术前诊断、出血量、手术时间、胆肠吻合、输液量、手术中使用胶体总量及C-反应蛋白、甲胎球蛋白、血乳酸、血红蛋白水平等资料进行分析,归纳肝破裂患者急救手术后腹腔感染的影响因素,并分析感染患者病原菌情况。结果手术中采用胆肠吻合的手术方式、C-反应蛋白以及术后腹水是肝破裂患者急救手术后腹腔感染的影响因素(P<0.05),32例腹腔感染患者共培养出127株菌株,其中革兰阴性菌为89株,占70.08%,其中大肠埃希菌占22.83%、肺炎克雷伯菌占12.60%,革兰阳性菌38株,占29.92%,以金黄色葡萄球菌(11.02%)、表皮葡萄球菌(7.87%)为主。结论肝破裂患者术后腹腔感染的影响因素有胆肠吻合的手术方式、CRP水平高以及术后腹水,感染病原菌以大肠埃希菌、肺炎克雷伯菌等革兰阴性菌最为常见。OBJECTIVE To explore the pathogens and their influencing factors of abdominal cavity infection in patients with liver rupture after emergency surgery.METHODS A total of 129 patients with liver rupture who underwent emergency surgery in Shangqiu First People’s Hospital from Mar.2017 to Sep.2019 were selected as the research objects.The data including age,gender and preoperative diagnosis,bleeding volume,operation time,biliary-enteric anastomosis,infusion volume,total amount of colloid used in surgery and C-reactive protein,alpha-fetoglobulin,blood lactate,hemoglobin levels were collected and analyzed,and the influencing factors of abdominal infection after emergency surgery in patients with liver rupture were summarized,and the pathogenic bacteria in infected patients were analyzed.RESULTS The surgical method of biliary-enteric anastomosis,high CRP level and postoperative ascites were the influencing factors of abdominal infection in patients with liver rupture after emergency surgery(P<0.05).A total of 127 strains were cultured from 32 patients with abdominal infection,of which 89 strains of Gram-negative bacteria,accounted for 70.08%,among them,Escherichia coli accounted for 22.83%and Klebsiella pneumoniae accounted for 12.60%.And 38 strains of Gram-positive bacteria,accounted for 29.92%,with the domination of Staphylococcus aureus(11.02%),and Staphylococcus epidermidis(7.87%).CONCLUSION The surgical method of biliary-enteric anastomosis,high CRP level and postoperative ascites were the influencing factors of abdominal cavity infection in patients with liver rupture.Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae were the most common pathogens.

关 键 词：肝破裂 腹腔感染 病原菌 影响因素 

分 类 号：R657.3[医药卫生—外科学]