不同类型梗阻性黄疸胆汁细菌生长分析

目的 观察不同类型梗阻性黄疸患者胆汁内细菌生长和抗菌药物敏感情况,旨在探讨逆行胰胆管造影(ERCP)治疗前后合理应用抗菌药物,以达预防和控制ERCP后感染并发症的发生.方法 对梗阻性黄疸患者接受ERCP引流者,在内镜下将无菌导管插入胆管,抽取淤滞的胆汁进行细菌学培养和药敏检测;分析细菌谱及与良恶性胆管梗阻、梗阻部位和程度的关系.结果 全组40例患者共检出细菌28例、32株,占70.00%,其中恶性梗阻细菌检出率84.38%,良性梗阻细菌检出率为12.50%,两组检出率差异有统计学意义(P<0.01);中低位梗阻细菌检出率为82.14%,高位梗阻细菌检出率41.67%;胆红素水平越高细菌检出率越高,不同梗阻部位细菌检出率差异有统计学意义(P<0.05),低、中、高水平细菌检出率分别为,低水平(20.2～171)μmol/L细菌检出率54.17%、中水平(172～342.1)μmol/L细菌检出率88.89%、高水平≥342.1 μmol/L细菌检出率100.00%,差异有统计学意义(P<0.05).结论 不同类型梗阻性黄疸细菌检出率不同,其中恶性梗阻、中低位梗阻和高胆红素梗阻为高危因素.

Growth Features of Bacteria from Bile in Different Types of Obstructive Jaundice

OBJECTIVE To observe the bacterial occurrence rate and its spectrum in bile during endoscopic treatment for obstructive jaundice. METHODS Forty patients with obstructive jaundice received ERCP drainage during from Jul to Dec in 2008. Every bile sample from the drainage was cultured for detection of bacterial occurrence and screening antibiotic sensitivities. RESULTS Twenty-eight patients were found bacterial positive in their bile drainage (70%). The bacteria detecting rate in the malignant obstruction patients was 84.38%, and that in the benign obstruction patients was 12.5%, the difference between the two groups had statistical significance (P<0.01). The detecting rate in medium and low site obstruction patients was 82.14% and that in high site obstruction patients was 41.67%, Bacteria were more often detected in patients with high level of bilirubin. The bacteria detecting rate for different obstructive sites had statistical significance (P<0.05). The bacteria detecting rate was 54.17% for the patients with low level of bilirubin (20.2-171 μmol/L), it was 88.89% for the patients with median level of bilirubin (172-342.1μmol/L), and 100.00% for the patients with high level of bilirubin (≥342.1μmol/L) which had statistical significant difference (P<0.05). CONCLUSIONS Bacteria detecting rate is different in different types of obstructive jaundice, we need to give more attention to the patient with high obstructive site in bile duct or high level of bilirubin for using proper antibiotics during ERCP treatment.