梗阻性黄疸经皮肝穿刺胆道引流术后胆道感染的病原菌特点及其危险因素分析

目的探讨梗阻性黄疸经皮肝穿刺胆道引流术后胆道感染病原菌特点及其危险因素.方法选择大连医科大学附属第一医院2017年9月—2019年9月行经皮肝穿刺胆道引流术治疗的梗阻性黄疸患者400例,根据患者术后是否发生胆道感染分为感染组63例与无感染组337例.分析导致感染的病原菌情况,以及影响术后感染的危险因素.结果63例术后感染患者共分离出71株病原菌,包括革兰阴性菌53株、革兰阳性菌13株、真菌5株.单因素分析显示,两组性别、体质量指数、梗阻部位、术前总胆红素、引流方式和住院时间差异无统计学意义(P>0.05);两组年龄、合并基础疾病、术前黄疸时间、术前谷丙转氨酶和引流量差异具有统计学意义(P<0.05).多因素Logistic回归分析显示,年龄>60岁、合并基础疾病、术前黄疸时间>14 d、术前谷丙转氨酶>150 U/L和引流量≤300 mL/d为影响经皮肝穿刺胆道引流术后胆道感染的独立危险因素.结论经皮肝穿刺胆道引流术后胆道感染的病原菌以革兰阴性菌为主,影响患者术后感染的因素较多,应采取针对性预防措施以避免术后感染的发生.

Pathogenic Bacteria Characteristics and Risk Factors of Biliary Tract Infection after Percutaneous Transhepatic Biliary Drainage for Obstructive Jaundice

Objective To explore the pathogenic bacteria characteristics and risk factors of postoperative infection of obstructive jaundice after percutaneous transhepatic biliary drainage.Methods From September 2017 to September 2019,a total of 400 patients with obstructive jaundice were treated by percutaneous hepatobiliary drainage(PTCD)in our hospital.According to whether infection occurred or not,they were divided into infection group(63 cases)and non-infection group(337 cases).The cause of pathogenic bacteria induced infection and risk factors of postoperative infection were analyzed.Results A total of 71 strains of pathogenic bacteria were isolated from 63 patients,including 53 strains of Gram-negative bacteria,13 strains of Gram-positive bacteria and 5 strains of fungi.Univariate analysis showed that there were no significant differences in gender,body mass index,obstruction site,preoperative TBIL,drainage mode and hospitalization time between the two groups(P>0.05);there were significant differences in age,combination with basic diseases,preoperative jaundice time,preoperative ALT and drainage volume between the two groups(P<0.05).Multivariate analysis showed that age>60 years old,combination with basic diseases,preoperative jaundice time>14 days,preoperative ALT>150 U/L and drainage flow>300 mL/d were independent risk factors for postoperative infection of obstructive jaundice.Conclusion The main pathogens of postoperative infection of obstructive jaundice are Gram-negative bacteria,and the postoperative infection is affected by many factors.In order to avoid postoperative infection,targeted preventive measures should be taken.