细菌性肝脓肿患者32例临床分析

发布时间：2018-11-28 17:45

【摘要】：目的本研究收集了32例细菌性肝脓肿患者病例,对相关临床因素.辅助检查结果、病原体和不同治疗方法的疗效进行分析和探讨,进一步提高对细菌性肝脓肿的认识。方法收集2013年7月-2013年12月在浙江大学医学院附属第一医院感染科住院治疗32例细菌性肝脓肿患者临床资料。按照单纯使用抗生素、抗生素+留置导管引流和抗生素+肝穿刺抽脓三种治疗方法将病人分为三组。使用Kruskal-Wallis检验,Mann-Whitney检验对三组病人的治疗相关指标进行统计学分析,比较不同治疗方法的临床疗效。结果 32例患者,年龄55.8+13.4岁(31-85岁)；男性患者21(65.63%)例,女性患者11(34.38%)例；以发热、纳差、腹痛为主要表现；基础疾病以糖尿病(12例,38%)、胆道系统疾病(9例,28%)和高血压(7例,22%)为主。17例患者行脓液培养,培养出9株肺炎克雷伯氏菌；7例患者行血液培养,培养出3株肺炎克雷伯氏菌。抗生素+留置导管引流比单纯使用抗生素更能降低患者的中性粒细胞比值(%)和纤维蛋白原水平,差异有统计学意义(P0.05)。结论浙江大学附属第一医院感染科细菌性肝脓肿患者的病原菌主要是肺炎克雷伯氏菌,对碳青霉烯类、青霉素(三代头孢)复合制剂、喹诺酮类抗菌药物均高度敏感。单纯使用抗生素、抗生素+留置导管引流和抗生素+肝穿刺抽脓三种治疗方法比较,在使用有效抗生素的基础上积极抽脓或引流更有利于细菌性肝脓肿患者的恢复。
[Abstract]:Objective to investigate the clinical factors of 32 patients with bacterial liver abscess. The results of adjuvant examination, the effect of pathogens and different treatment methods were analyzed and discussed to further improve the understanding of bacterial liver abscess. Methods the clinical data of 32 patients with bacterial liver abscess were collected from July 2013 to December 2013 in the first Hospital infection Department of Zhejiang University Medical College. Patients were divided into three groups according to the simple use of antibiotics, antibiotic indwelling catheter drainage and antibiotic liver puncture drainage. Kruskal-Wallis test and Mann-Whitney test were used to compare the clinical efficacy of different treatment methods. Results there were 32 patients aged 55.8 13.4 years (31-85 years), 21 males (65.63%) and 11 females (34.38%) with fever, anorexia and abdominal pain as the main manifestations. The basic diseases were diabetes mellitus (12 cases, 38%), biliary tract diseases (9 cases, 28%) and hypertension (7 cases, 22%). Three strains of Klebsiella pneumoniae were cultured by blood culture in 7 patients. Antibiotic indwelling catheter drainage can lower the neutrophil ratio (%) and fibrinogen level than the use of antibiotics alone, the difference was statistically significant (P0.05). Conclusion Klebsiella pneumoniae is the main pathogen of bacterial liver abscess in the first Hospital affiliated to Zhejiang University. It is highly sensitive to carbapenem penicillin (third generation cephalosporin) and quinolone antibiotics. Simple use of antibiotics, antibiotic indwelling catheter drainage and antibiotic liver puncture drainage were more beneficial to the recovery of bacterial liver abscess.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.4

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