经皮肝穿置管连续灌注引流治疗糖尿病合并细菌性肝脓肿的疗效及影响因素分析

目的：对比研究超声介入治疗糖尿病合并细菌性肝脓肿（DBLA）的2种置管引流方法（连续灌注和单纯引流）的临床疗效，并进一步分析连续灌注引流术后拔管时间和住院时间的影响因素。方法：将170例DBLA的患者随机分为2组，分别采取超声引导下经皮肝穿刺置管连续灌注（连续灌注组，85例）和单纯引流（单纯引流组，85例）2种方法进行治疗，统计分析2组患者的术后并发症、术后体温恢复正常的时间、术后外周血白细胞计数恢复正常的时间、术后拔管时间以及术后住院时间。探讨连续灌注组介入术后拔管时间和住院时间的影响因素。运用LASSO回归分析筛选变量及计算系数，并由此构建术后拔管时间和住院时间的预测模型。结果：2组患者术后并发症发生率、术后体温恢复正常时间、术后外周血白细胞计数恢复正常时间差异均无统计学意义（P＞0.05）。连续灌注组平均术后拔管时间为（21.1±12.4）d，明显短于单纯引流组的（29.1±14.9）d（P＜0.05）；连续灌注组平均术后住院时间为（16.2±6.6）d，明显短于单纯引流组的（27.8±8.0）d（P＜0.05）。连续灌注组术后拔管时间的影响因素为：脓肿含气、脓肿多房、合并胆道结石、血浆白蛋白和体质量指数（BMI）（P＜0.05）；术后住院时间的唯一影响因素为：合并感染性休克（P＜0.05）。LASSO回归构建预测模型：术后拔管时间=0.06×白细胞-0.72×血浆白蛋白+1.99×多房+6.86×胆道结石+ 0.94×BMI；术后住院时间=0.21×甘油三酯+1.79×感染性休克。结论：对于DBLA，超声引导下经皮肝穿置管连续灌注引流的临床疗效优于单纯引流术；超声图像特征为脓肿含气、脓肿多房，患者合并胆道结石、低蛋白血症或高BMI均将延长术后拔管时间；患者合并感染性休克将延长术后住院时间。

Analysis of the therapeutic effect and influence factors on percutaneous catheter drainage with continuous instillation for the treatment of bacterial liver abscess with diabetes mellitus

Objective: To compare the clinical value of two methodes of ultrasound guided percutaneous catheter drainage for the treatment of bacterial liver abscess with diabetes mellitus (continuous instillation and simple catheter drainage). Furthermore, the factors which could influence the postoperative extubation time and length of hospital stay were also identified. Methods: One hundred and seventy cases of diabetic patients with bacterial liver abscess were randomly divided into 2 groups, which were all under the ultrasound interventional treatment. Eighty-five patients underwent simple catheter drainage, and 85 patients underwent continuous instillation. Patients were followed up to assess the postoperative complications, postoperative body temperature and peripheral blood leukocyte returned to normal time, postoperative extubation time, and length of hospital stay. The factors which could influence the postoperative extubation time and length of hospital stay were also identified in instillation group, in which 85 cases underwent continuous instillation by ultrasound guided percutaneous hepatic puncture. In addition, a multicomponent prediction model for predicting postoperative extubation time and length of hospital stay were developed using LASSO regression. Results: There was no statistically significant between the two groups regarding the incidence of postoperative complications, peripheral blood leukocyte and postoperative body temperature returned to normal time (P>0.05). Postoperative extubation time in instillation group was (21.1±12.4) d, significantly shorter than that in drainage group (29.1±14.9) d (P<0.05), hospitalization time in instillation group was (16.2±6.6) d, also significantly shorter than that in drainage group (27.8±8.0) d (P<0.05). The influence factors of postoperative extubation time is: abscesses gas, locule number, combined biliary calculi, plasma albumin and body mass index (BMI) (P<0.05); The only influence factor for postoperative hospital stay was septic shock (P<0.05). The multicomponent prediction model for?predicting postoperative extubation time=0.06 leukocyte -0.72 albumin+1.99 more room+6.86 biliary stones+0.94 BMI; postoperative hospital stay=0.21 triacylglycerol +1.79 septic shock. Conclusion: Continuous instillation was more effective than simple catheter drainage in the treatment of diabetic bacterial liver abscess. Ultrasound image characteristics of abscesses gas, locule number, patients with biliary calculi, hypoalbuminemia or high BMI will extend the postoperative extubation time, merge patients with septic shock will extend the postoperative hospital stay.