摘要
目的探讨高浓度氧气置换二氧化碳(CO2)气腹对普外科患者腹腔镜术后腹腔厌氧菌感染的影响。方法选择2014年2月-2016年10月于医院普外科择期行腹腔镜手术治疗的120例患者作为研究对象,按随机数字表法分为对照组与试验组,每组各60例,对照组常规行腹腔镜手术,术后以CO2置换腹腔内CO2,试验组术后以氧气置换腹腔内CO2,行高浓度氧气置换,术后1d、3d留取腹腔引流管引流液进行细菌培养,记录细菌培养结果,统计患者腹腔厌氧菌感染率及主要菌种分布,测定术后1d、3d两组血白细胞计数(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)水平的变化,同时测定术后1d、3d患者肝功能指标丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、直接胆红素(DBIL)、总胆红素(TBIL)的变化。结果术后1d、3d两组患者WBC、CRP、PCT水平均有不同程度的降低(P<0.001),试验组患者术后3dCRP、PCT水平低于对照组患者(P<0.05);术后1d、3d,两组肝功能指标均降低,差异有统计学意义(P<0.001),但组间比较差异无统计学意义;试验组患者术后1d、术后3d腹腔引流液厌氧菌感染阳性率分别为13.3%、5.0%,均低于对照组患者的30.0%、16.7%(P<0.05)。结论高浓度氧气置换CO2气腹可减少腹腔镜术后腹腔厌氧菌感染率,减轻患者术后炎症反应。
OBJECTIVE To investigate the effect of high-concentration oxygen replacing CO2 pneumoperitoneum on abdominal anaerobic infection in patients after laparoscopic surgery in the department of general surgery.METHODS A total of 120 patients undergoing laparoscopic surgery in the department of general surgery of our hospital during the period of Feb.2014 to Oct.2016 were selected as the subjects,and they were randomly divided into the control group and the experimental group,with 60 cases in each group.The control group was treated by conventional laparoscopic surgery,and CO2 in the abdominal cavity was replaced by CO2 after surgery.In the experimental group,CO2 in the abdominal cavity was replaced by oxygen,and high-concentration oxygen replacement was performed.The drainage liquid of the abdominal drainage tube was collected for bacterial culture on the1 st and 3 rd day after surgery.The results of bacterial culture were recorded,and the abdominal anaerobic infection rate and the distribution of main strains were statistically analyzed.The changes of white blood cell count(WBC),procalcitonin(PCT)and C reactive protein(CRP)on the 1 st and 3 rd day after surgery were determined.Meanwhile,changes of liver function indexes,alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBIL)and total bilirubin(TBIL)on day 1 and day 3 after surgery were also determined.RESULTS The WBC,PCT and CRP in both groups were decreased to different degrees on day 1 and day 3 after operation(P<0.001),and the levels of CRP and PCT in the experimental group were significantly lower than those in the control group on day 3 after operation(P<0.05).The liver function indexes in both groups were significantly decreased on day 1 and day 3 after operation(P<0.001).The positive rates of anaerobic infection in the abdominal drainage solution in the experimental group were 13.3%and 5.0%on day 1 and day 3 after operation,both significantly lower than those in the control group which were 30.0%and 16.7%respectively(P<0.05).CONCLUSION High-concentration oxygen replacing CO2 pneumoperitoneum can reduce the abdominal anaerobic infection rate after laparoscopic surgery and relieve postoperative inflammatory response.
作者
赵伟
赵善峰
唐思锋
王德友
马国良
张光勇
ZHAO Wei;ZHAO Shan-feng;TANG Si-feng;WANG De-you;MA Guo-liang;ZHANG Guang-yong(Laiwu People's Hospital,Laiwu,Shandong 271100,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第24期3788-3791,共4页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(1202016)
关键词
腹腔镜手术
腹腔感染
普外科
CO2气腹
氧气置换
Laparoscopic surgery
Abdominal infection
Department of general surgery
CO2 pneumoperitoneum
Oxygen replacement
