经皮肝穿刺胆道引流术前预防性使用抗生素对术后胆道感染的影响  

The effect of prophylactic use of antibiotics before percutaneous transhepatic cholangial drainage on postoperative biliary tract infection

作　　者：雷东酿 娄琳滟 江哲宇 黄昊 蒋天鹏 周石 王黎洲 LEI Dongniang;LOU Linyan;JIANG Zheyu;HUANG Hao;JIANG Tianpeng;ZHOU Shi;WANG Lizhou(Sehool of Medica Imagng Guichou Medical Uninersity Guiyng Guizhou Province 5004,China)

机构地区：[1]贵州医科大学医学影像学院,贵阳550004

出　　处：《介入放射学杂志》2022年第9期879-882,共4页Journal of Interventional Radiology

摘　　要：目的 探讨经皮肝穿刺胆道引流(percutaneous transhepatic cholangial drainage, PTCD)术前预防性使用抗生素对术后胆道感染的影响因素。方法 选取贵州医科大学医学影像学院和贵州医科大学附属肿瘤医院2016年6月至2021年6月进行PTCD治疗的患者325例。将术前0.5~2.0 h预防性使用抗生素的25例患者作为观察组,未预防性使用抗生素的300例患者作为对照组,对比两组患者的基本情况和术后感染发生情况。单因素及多因素logistic回归分析PTCD术后感染的影响因素。结果 2组患者基本情况差异无统计学意义(均P>0.05)。两组患者术后胆道感染率分别为8.0%、20.7%,差异无统计学意义(χ^(2)=2.34,P=0.13)。单因素分析显示,引流方式、术前血红蛋白、术前总胆红素、术前PT与PTCD术后胆道感染有关;多因素logistic回归分析结果显示,引流方式(OR=3.64,95%CI:2.026~6.542,P<0.05)和术前血红蛋白(OR=0.97,95%CI:0.974~0.998,P<0.05)是PTCD术后发生感染的独立影响因素。结论 预防应用抗生素对PTCD术后胆道感染率无显著影响,患者术前低血红蛋白,PTCD术后易发生胆道感染,采用内外引流也易导致PTCD术后胆道感染。Objective To discuss the effect of prophylactic use of antibiotics before percutaneous transhepatic cholangial drainage(PTCD) on postoperative biliary infection, and to analyze the factors that influence the postoperative biliary tract infection. Methods The clinical data of a total of 325 patients, who received PTCD treatment between June 2016 and June 2021 at the School of Medical Imaging of Guizhou Medical University and the Affiliated Cancer Hospital of Guizhou Medical University, were collected. Of the 325patients, prophylactic antibiotics at 0.5-2.0 hours before PTCD was used in 25(study group), and preoperative prophylactic antibiotics was not used in 300(control group). The basic clinical data and the incidence of postoperative biliary infection were compared between the two groups. The univariate analysis and the multivariate logistic regression analysis were adopted to analyze the influencing factors of post-PTCD infection.Results There were no statistically significant differences in the basic clinical data between the two groups(P>0.05). The incidence of post-PTCD infection in the study group and the control group was 8.0% and 20.7%respectively, the difference between the two groups was not statistically significant(χ^(2)=2.34, P=0.13). Univariate analysis showed that drainage method, preoperative hemoglobin level, preoperative total bilirubin level,preoperative PT level were correlated to the post-PTCD biliary tract infection. Multivariate logistic regression analysis indicated that the drainage method(OR=3.64, 95%CI=2.026-6.542, P<0.05) and the preoperative hemoglobin level(OR=0.97, 95%CI=0.974-0.998, P<0.05) were the independent risk factors for post-PTCD biliary tract infection. Conclusion The prophylactic use of antibiotics before PTCD bears no significant relationship to post-PTCD biliary tract infection. The lower the preoperative hemoglobin level is, the more likely the post-PTCD biliary infection will occur, besides, in the condition of simultaneous use of internal drainage and external drai

关 键 词：经皮肝穿刺胆道引流术 感染率 梗阻性黄疸 抗生素 

分 类 号：R735.8[医药卫生—肿瘤]