介入性超声在细菌感染性肝脓肿患者中的应用效果研究

发布时间：2018-03-30 08:55

本文选题：超声　切入点：细菌性肝脓肿　出处：《中华医院感染学杂志》2017年16期

【摘要】：目的探讨介入性超声在细菌性肝脓肿患者中的应用效果,为临床治疗提供依据。方法选取2011年7月-2016年7月于医院肝胆外科住院诊疗的细菌感染性肝脓肿患者82例,根据手术方式,将患者分为观察组52例和对照组30例;观察组行"超声引导下经皮肝脓肿穿刺置管引流术",对照组行腹腔镜肝脓肿切开引流术,术前行常规检查,接受超声引导经皮穿刺置管引流术治疗患者,抽出脓液行菌株鉴定和药敏试验,比较两组患者的治愈率、体温恢复正常时间、住院时间及费用。结果观察组52例细菌性肝脓肿患者中,脓液培养阳性36例,阳性率为69.23%,共检出革兰阴性菌30株占83.33%,革兰阳性菌6株占16.67%;血培养阳性15例,阳性率为28.85%,共检出革兰阴性菌13株占86.67%,革兰阳性菌2株占13.33%;革兰阴性菌中肺炎克雷伯菌对氨苄西林、哌拉西林、环丙沙星和庆大霉素耐药率较高,均≥80.00%,对左氧氟沙星、阿米卡星、美罗培南、头孢噻肟和头孢哌酮/舒巴坦耐药率为0;革兰阳性菌中金黄色葡萄球菌对万古霉素、利福平和替考拉宁耐药率为0;所有患者一次性穿刺成功率100.00%;所有患者均治愈出院,治愈率100.00%;无并发症发生,半年后复查,均无复发;观察组体温恢复正常时间和住院费用较对照组显著降低(P0.05)。结论超声引导经皮穿刺置管引流术结合抗菌药物治疗细菌性肝脓肿效果显著,安全性高,疗效与腹腔镜手术相同,但超声引导经皮穿刺置管引流术患者痛苦轻、创伤小、恢复快,临床中应首选该方法来治疗细菌性肝脓肿。
[Abstract]:Objective to investigate the effect of interventional ultrasound in the treatment of bacterial liver abscess. Methods 82 patients with bacterial infective liver abscess were selected from July 2011 to July 2016. According to the operation mode, the patients were divided into the observation group (52 cases) and the control group (30 cases). Patients were treated with ultrasound guided percutaneous catheterization and drainage. The bacterial strain identification and drug sensitivity test were carried out to compare the cure rate and temperature recovery time between the two groups. Results among the 52 patients with bacterial liver abscess, 36 cases were positive in pus culture, the positive rate was 69.23%. A total of 30 Gram-negative bacteria (83.33%), 6 Gram-positive bacteria (16.67%), 15 positive blood cultures (15 cases) were detected. The positive rate was 28.85.The Gram-negative bacteria accounted for 86.67 and Gram-positive bacteria accounted for 13.33.The resistant rates of Klebsiella pneumoniae to ampicillin, piperacillin, ciprofloxacin and gentamicin were higher, all of them were more than 80.00g, and the resistance rates of Klebsiella pneumoniae to levofloxacin were higher than those of gentamycin. The resistance rates of amikacin, meropenem, cefotaxime and cefoperazone / sulbactam were 0. Staphylococcus aureus in Gram-positive bacteria was vancomycin, The drug resistance rate of rifampicin and teicoplanin was 0, the success rate of puncture was 100.00000 in all patients, all patients were cured and discharged, the cure rate was 100.00. Conclusion Ultrasound-guided percutaneous catheterization and drainage combined with antimicrobial agents are effective and safe in the treatment of bacterial liver abscess. But ultrasonic guided percutaneous catheterization and drainage has the advantages of mild pain, little trauma and quick recovery. This method should be chosen in clinical treatment of bacterial liver abscess.
【作者单位】：海南省人民医院超声科;
【分类号】：R445.1;R575.4

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