摘要
目的探讨胰十二指肠切除术(PD)后腹腔感染的主要病原菌分布及危险因素。方法回顾性分析天津市第三中心医院2016年1月-2019年1月行PD术的107例患者的临床资料,通过单因素分析与多因素Logistic分析方法筛选出与术后发生腹腔感染相关的因素。结果107例患者中,符合腹腔内感染诊断标准的共有32例,腹腔感染率为29.91%。其中分离培养出细菌总计85株,革兰阳性菌22株(占25.88%);革兰阴性菌55株(64.71%),真菌8株(9.41%)。单因素分析结果显示术前接受化疗、术前胆道引流、胰瘘、胆瘘、腹腔出血和肺部感染是腹腔感染发生的危险因素;进一步将其纳入多因素Logistic回归分析,提示胰瘘(OR=16.891,P<0.001)和胆瘘(OR=9.666,P=0.029)是PD术后腹腔感染的独立危险因素。受试者工作特征曲线(ROC)分析显示该回归模型具有较高的诊断价值[曲线下面积(AUC)=0.886±0.044,P<0.05]。Hosmer-Lemeshow Test显示χ^2=2.844,P=0.584,说明该模型拟合度较好。结论PD术后腹腔引流液的微生物培养结果以革兰阴性菌为主,积极防治胰瘘和胆瘘可降低腹腔感染的发生率。
OBJECTIVE To explore the distribution of major species of pathogens isolated from the pancreaticoduodenectomy(PD)patients with postoperative abdominal infection and analyze the risk factors.METHODS The clinical data of 107 patients who underwent PD in Tianjin Third Central Hospital from Jan.2016 to Jan.2019 were retrospectively analyzed,and the related factors for the postoperative abdominal infection were screened out by means of univariate analysis and multivariate logistic analysis.RESULTS Among the 107 patients,32 met the diagnostic criteria for intraabdominal infection,with the incidence rate of abdominal infection 29.91%.A total of 85 strains of bacteria were isolated,22(25.88%)of which were gram-positive bacteria,55(64.71%)were gram-negative bacteria,and 8(9.41%)were fungi.The result of univariate analysis showed that preoperative chemotherapy,preoperative biliary drainage,pancreatic fistula,biliary fistula,abdominal hemorrhage and pulmonary infection were the risk factors for the abdominal infection.The multivariate logistic regression analysis indicated that pancreatic fistula(OR=16.891,P<0.001)and biliary fistula(OR=9.666,P=0.029)were the independent risk factors for the postoperative abdominal infection in the PD patients.Receiver operating characteristic(ROC)curve analysis showed that the regression model had high diagnostic value,with the area under curve(AUC)(0.886±0.044,P<0.05).Hosmer-Lemeshow Test indicated thatχ^2=2.844,P=0.584,and the model fitted the data well.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from postoperative peritoneal drainage fluid specimens of the PD patients,and the active prevention and treatment of pancreatic fistula and biliary fistula can reduce the incidence of abdominal infection.
作者
王素梅
张健东
张金卷
刘树业
WANG Su-mei;ZHANG Jian-dong;ZHANG Jin-juan;LIU Shu-ye(Tianjin Third Central Hospital,Tianjin 300170,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第13期2018-2022,共5页
Chinese Journal of Nosocomiology
基金
天津市卫生行业重点攻关基金资助项目(15KG114)。
