摘要
目的 探析消化道肿瘤患者经内镜下黏膜剥离术后并发感染的病原菌分布特点及危险因素。方法 选取2020-2021年于新乡市中心医院消化道肿瘤接受内镜下黏膜剥离术并发术后感染的60例患者资料。回顾性分析参与本次研究患者的临床资料及病原菌情况,随机选取100例同期消化道肿瘤患者进行内镜下黏膜剥离术未发生感染者,通过对比两组患者的临床资料,分析消化道肿瘤患者内镜下黏膜剥离术后感染的危险因素。采集患者标本,经细菌培养分离后,进行病原菌鉴定。内镜黏膜下剥离术治疗后发生感染,通过^(14)C-尿素呼气试验及临床病理确诊为幽门螺杆菌感染患者,将其分为对照组与观察组,观察组在对照组治疗基础上,连续两周给予胶体果胶铋胶囊治疗。通过分析两组患者的幽门螺杆菌根治率及白介素10水平,对治疗效果进行评估。结果 60例消化道肿瘤患者行内镜下黏膜剥离术后并发感染患者中,11例出现并发症,发生率为18.33%。其中,3例患者发生术中穿孔,2例患者于术后24 h内发生术后出血,2例患者术后出现食管返流,4例患者术后延迟出血。共培养分离出64株病原菌,革兰阴性菌54株,革兰阳性菌8株,真菌2株。20例内镜黏膜下剥离术后感染幽门螺杆菌患者随机分为两组。对照组采用三联治疗法,观察组采用四联治疗法。对比两组患者的幽门螺杆菌根治率,对照组患者幽门螺杆菌根治率70%,观察组患者幽门螺杆菌根治率90%。两组患者IL-10水平改善情况,观察组优于对照组,对比差异有统计学意义(P<0.05)。对比感染组与非感染组患者的临床资料,结果显示,年龄、手术时间、用药天数、免疫功能低下、合并糖尿病、术前白蛋白水平、侵入性操作对比差异有统计学意义(P<0.05),性别、合并高血压对比差异无统计学意义(P>0.05)。以是否发生术后感染为因变量,进一步进行二元Logistic回归分析,结果显示,年龄≥60岁、手术时间≥60 min、用药天数≥15 d、合并糖尿病、术前白蛋白水平<30 g/L是消化道肿瘤患者内镜下黏膜剥离术后感染的独立危险因素。结论 消化道肿瘤患者内镜下黏膜剥离术后感染患者,以大肠埃希菌和幽门螺杆菌为主要病原菌。基础治疗方案上给予胶体果胶铋胶囊治疗对幽门螺杆菌感染患者具有良好治疗效果。年龄大、手术时间久、用药天数长、合并糖尿病、术前白蛋白水平低是消化道肿瘤患者内镜下黏膜剥离术后感染的危险因素。
Objective To explore the distribution of pathogens and risk factors of infection in patients with gastrointestinal tumors after endoscopic mucosal dissection. Methods From January 2020 to December 2021,60 patients with digestive tract tumors was selected, who underwent endoscopic mucosal dissection and postoperative infection in Xinxiang Central Hospital. Retrospective analysis was made on the clinical data and pathogens of patients participating in this study. 100 patients with digestive tract tumors in the same period who were not infected after endoscopic mucosal stripping were randomly selected. By comparing the clinical data of the two groups of patients, the risk factors of infection after endoscopic mucosal stripping were analyzed. Samples of patients were collected, cultured, isolated, and pathogens identified. After the treatment of endoscopic submucosal dissection, infection occurred. The patients with Helicobacter pylori infection were confirmed by^(14)C urea breath test and clinical pathology. They were divided into control group and observation group. The observation group was treated with colloidal bismuth pectin capsule for two consecutive weeks on the basis of the treatment of the control group. The therapeutic effect was evaluated by analyzing the eradication rate of H. pylori and the level of IL-10 in the two groups. Results Among 60 patients with digestive tract tumors complicated with infection after endoscopic mucosal dissection, 11 patients had complications(18.33%). Among them, 3 patients had intraoperative perforation, 2 patients had postoperative bleeding within 24 hours after surgery, 2 patients had esophageal reflux after surgery, and 4 patients had delayed bleeding after surgery. A total of 64 pathogenic bacteria were isolated, including 54 gram-negative bacteria, 8 gram-positive bacteria and 2 fungi. 20 patients with H. pylori infection after endoscopic submucosal dissection were randomly divided into two groups. And they were treated with triple therapy in the control group and quadruple therapy in the observation group. The eradication rate of H. pylori was compared between the two groups. The eradication rate of H. pylori was 70% in the control group and 90% in the observation group. The improvement of IL-10 level in the observation group was better than that in the control group, and the difference was statistically significant(P<0.05). The clinical data of patients in the infection group and the non infection group were compared. The results showed that there were statistically significant differences in age, operation time, medication days, low immune function, diabetes, preoperative albumin level, and invasive procedures(P>0.05). With the occurrence of postoperative infection as the dependent variable, further binary logistic regression analysis was carried out. The results showed that age ≥ 60 years, operation time ≥ 60 minutes, medication days ≥ 15 days, diabetes, preoperative albumin level<30 g/L were independent risk factors for infection after endoscopic mucosal dissection in patients with digestive tract tumors. Conclusion E.coli and H. pylori were the main pathogens in the infected patients after endoscopic mucosal dissection of digestive tract tumors. Colloidal bismuth pectin capsule was given to the patients with H. pylori infection on the basis of the basic treatment plan, which showed better effect. Old age, long operation time, long medication days, diabetes, low preoperative albumin level are the risk factors for infection after endoscopic mucosal dissection in patients with digestive tract tumors.
作者
祁代华
姜红建
陈胜
段莎莎
QI Dai-hua;JIANG Hong-jian;CHEN Sheng;DUAN Sha-sha(Xinxiang Central Hospital,Xinxiang 453000,Henan,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2023年第2期233-237,共5页
Journal of Pathogen Biology
关键词
消化道肿瘤
内镜下黏膜剥离术
术后感染
幽门螺杆菌
危险因素
digestive tract tumor
endoscopic mucosal dissection
postoperative infection
Helicobacter pylori
risk factors
