血管内介入治疗围手术期预防性使用抗生素的临床意义

发布时间：2018-11-21 10:37

【摘要】：目的：分析我院TACE术及TIPS术在围手术期应用抗生素对术后感染的预防价值。方法：收集于2007年1月至2013年3月在重庆医科大学附属第二医院住院且行肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）的肝癌患者资料以及2011年1月至2013年3月行颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt，TIPS)的肝硬化患者资料。根据TACE和TIPS围手术期是否预防性应用抗生素，将病例分为预防性使用抗生素组和未预防性使用抗生素组，比较两组术后感染率，并分析术后感染相关危险因素。结果： 1.纳入TACE术共计538例，包括男501例，女37例，TIPS术共计61例，包括男47例，女14例。TACE术预防性使用抗生素组术后感染率为16.7%（60/359），未预防性使用抗生素组术后感染率为20.1%(36/179), P=0.33。 2.TACE术未预防性使用抗生素组与预防性使用抗生素组在术后呼吸道感染、不明原因感染、腹膜炎、泌尿系感染、败血症、胆道感染、肝脓肿、胸膜炎、消化道感染的发生率差异无统计学意义，P0.05。 3.单因素及多因素分析提示肝功能Child-Pugh分级、手术时间大于2h为TACE术后感染的独立影响因素。 4.TIPS术预防性使用抗生素组术后感染率为33.3%(5/15)，未预防性使用抗生素组术后感染率为34.8%(16/46)，P=0.92。 5.TIPS术后呼吸道感染、泌尿系感染、败血症、不明原因感染的发生率差异无统计学意义，P0.05。 6.多因素分析提示年龄、肝功能Child-Pugh分级为TIPS术后感染的独立影响因素。结论：肝功能Child-Pugh chlid A级患者TACE术及TIPS术围手术期不必常规预防性使用抗生素，，对于肝功能差、手术时间长、老年等高危感染因素患者，酌情选择适宜的抗生素更有临床预防价值。
[Abstract]:Objective: to analyze the value of TACE and TIPS in preventing postoperative infection. Methods: (transcatheter arterial chemoembolization, was collected from January 2007 to March 2013 in the second affiliated Hospital of Chongqing Medical University and performed transcatheter arterial chemoembolization (transcatheter arterial chemoembolization,). (TACE) and cirrhosis patients undergoing intrahepatic jugular portosystemic shunt (transjugular intrahepatic portosystemic shunt,TIPS) from January 2011 to March 2013. According to the prophylactic use of antibiotics in the perioperative period of TACE and TIPS, the patients were divided into two groups: prophylactic use of antibiotics and non-prophylactic use of antibiotics. The postoperative infection rate was compared between the two groups, and the risk factors of postoperative infection were analyzed. Results: 1. A total of 538 cases were included in TACE procedure, including 501 males, 37 females and 61 TIPS patients, including 47 males and 14 females. The infection rate was 16.7% (60 / 359) in the TACE group. The postoperative infection rate was 20.1% (36 / 179) in the non-prophylactic antibiotic group and 0.33% in the control group. Postoperative respiratory tract infection, unknown cause infection, peritonitis, urinary tract infection, septicemia, biliary tract infection, liver abscess, pleurisy, There was no significant difference in the incidence of digestive tract infection (P 0.05). 3. Univariate and multivariate analysis suggested that Child-Pugh grade of liver function and operation time more than 2 h were independent factors of infection after TACE. The postoperative infection rate was 33.3% (5 / 15) in the 4.TIPS group and 34.8% (16 / 46) in the non-prophylactic antibiotic group. There was no significant difference in the incidence of respiratory tract infection, urinary tract infection, septicemia and unknown cause infection after 5.TIPS (P 0.05). 6. Multivariate analysis showed that age and Child-Pugh grade of liver function were independent factors of infection after TIPS. Conclusion: the perioperative period of TACE and TIPS in Child-Pugh chlid A patients with liver function does not need routine prophylactic use of antibiotics. It is necessary for patients with high risk infection such as poor liver function, long operation time, old age and so on. The choice of appropriate antibiotics is more valuable for clinical prevention.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R735.7

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