消化道肿瘤患者内镜下黏膜剥离术后感染的病原菌分布及危险因素分析  

Pathogen distribution and risk factors of infection after endoscopic mucosal dissection for gastrointestinal tumors

作　　者：杨磊[1] 程亭亭 贾璐璐 Yang Lei;Cheng Tingting;Jia Lulu(Digestive Endoscopy Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院消化内镜中心,郑州450052

出　　处：《中国实用医刊》2023年第24期16-19,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析消化道肿瘤患者内镜下黏膜剥离术(ESD)后感染的病原菌分布情况及其危险因素。方法抽取2022年3月至2023年3月郑州大学第一附属医院收治的因消化道肿瘤行内镜下黏膜剥离术后感染患者91例为感染组,另抽取同期于医院因消化道肿瘤行内镜下黏膜剥离术后无感染患者60例为未感染组。回顾性分析入组者临床资料,记录感染组并发症、感染病原菌分布情况,并对消化道肿瘤行内镜下黏膜剥离术后感染的危险因素进行单因素及多因素Logistic回归分析。结果感染组并发症发生率为18.68%(17/91),其中术后延迟出血发生率最高(6.59%,6/91),其次是术中穿孔(5.49%,5/91)。感染组经病原菌培养共分离出97株病原菌,其中革兰阴性菌82株(84.54%),革兰阳性菌12株(12.37%),真菌3株(3.09%)。感染组年龄≥60岁、手术时间≥60 min、用药时间≥15 d、合并糖尿病、免疫力低下、侵入性操作及术前白蛋白<30 g/L者占比高于未感染组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、用药时间≥15 d、手术时间≥60 min、术前白蛋白水平<30 g/L及合并糖尿病是消化道肿瘤行内镜下黏膜剥离术后感染的独立危险因素(P<0.05)。结论消化道肿瘤行ESD术后感染的主要病原菌为幽门螺杆菌及大肠埃希菌;手术时间、年龄、用药时间、合并糖尿病及术前白蛋白水平均是其独立危险因素,需对以上因素进行针对性预防及控制,以降低感染率。Objective To analyze the distribution of pathogenic bacteria and the risk factors of infections after endoscopic mucosal dissection(ESD)for gastrointestinal tumors.Methods Ninety-one patients with infection after ESD for gastrointestinal tumor treated in the First Affiliated Hospital of Zhengzhou University from March 2022 to March 2023 were selected as the infected group.Sixty patients without infection after ESD for gastrointestinal tumor were selected as the uninfected group during the same period.The clinical data of the enrolled patients were retrospectively analyzed.The incidence of complications and distribution of pathogens in the infected group was recorded.The univariate and multivariate logistic regression analysis were performed on the risk factors for infection after ESD for gastrointestinal tumors.Results The incidence of complications in the infected group was 18.68%(17/91),among which the incidence of delayed postoperative bleeding was the highest(6.59%,6/91),followed by intraoperative perforation(5.49%,5/91).A total of 97 strains of pathogenic bacteria were isolated from the infected group,including 82 strains(84.54%)of Gram-negative bacteria,12 strains(12.37%)of Gram-positive bacteria,and 3 strains(3.09%)of Fungi.The proportion of patients≥60 years old,with length of operation≥60 min,with medication time≥15 days,complicated by diabetes mellitus,with immunocompromise,with invasive operation and with preoperative albumin<30 g/L in the infected group were higher than those in the uninfected group(P<0.05).Results of multivariate logistic regression analysis showed that age≥60 years,medication time≥15 days,length of operation≥60 min,preoperative albumin level<30 g/L,and diabetes mellitus were independent risk factors for infection after ESD for gastrointestinal tumors(P<0.05).Conclusions The main pathogens of post-ESD infection in patients with gastrointestinal tumors are Helicobacter pylori and Escherichia coli.Length of operation,age,medication time,diabetes mellitus and preoperative al

关 键 词：肿瘤 消化道 危险因素 内镜下黏膜剥离术 术后感染 

分 类 号：R735[医药卫生—肿瘤]