摘要
目的 分析解剖性肝切除术后腹腔感染的影响因素及早期血清指标的预测价值。方法 解剖性肝切除术患者100例,依据术后是否发生腹腔感染分为感染组(n=25)、非感染组(n=75),分析腹腔感染病原学特点、对比感染组与非感染组性别、年龄、术前白蛋白(Alb)、手术相关指标等临床资料;分析影响腹腔感染的因素,比较感染组与非感染组的预后转归情况及肝功能[总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、凝血酶原时间(PT)]变化;检测两组早期感染性血清指标[C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)],并分析术后第3天内平均CRP、PCT、IL-6、TNF-α对腹腔感染的预测价值。结果 25例出现腹腔感染(25.00%),共检出病原菌42株,革兰阴性菌20株,革兰阳性菌22株;年龄、合并糖尿病、手术时间、术中胶体使用量、行胆管切开引流或胆肠吻合为术后腹腔感染独立危险因素,血清Alb为保护因素(P<0.05);感染组住院时间较非感染组延长,感染组住院费用较非感染组更高(P<0.05),感染组术前DBIL、ALT及术后第1天DBIL高于非感染组(P<0.05),两组28 d死亡率比较,差异无统计学意义(P>0.05);感染组术前、术后第1天、第3天CRP、PCT、IL-6、TNF-α均高于非感染组(P<0.05);术后第3天内平均CRP、PCT、IL-6、TNF-α预测腹腔感染的ROC曲线下面积(AUC)分别为0.821、0.817、0.813、0.772。结论 年龄、合并糖尿病、手术时间等是解剖性肝切除术后腹腔感染的影响因素,检测CRP、PCT、IL-6、TNF-α对早期腹腔感染有一定的预测价值。
Objective To analyze the influencing factors of abdominal infection after anatomical hepatectomy,and the predictive value of early serum indices.Methods A total of 100 patients with anatomical hepatectomy were divided into the infected group(n=25)and the non-infected group(n=75)based on the presence or absence of abdominal infection after operation.The etiological characteristics of abdominal infection were analyzed,and clinical data such as gender,age,preoperative albumin(Alb),and surgical related indicators were compared between the infected group and non-infected group.The factors influencing abdominal infection were analyzed,and the prognosis and changes in liver function[total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and prothrombin time(PT)]between the infected group and the non-infected group were compared.The early infectious serum indices[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)]of the two groups were detected,and the predictive value of average CRP,PCT,IL-6,and TNF-αwithin the third day after operation for abdominal infection was analyzed.Results Twenty-five patients(25.00%)were infected with abdominal infection.42 pathogenic bacteria strains were detected,including 20 Gram-negative bacteria strains and 22 Gram-positive bacteria strains.Age,diabetes,operation time,intraoperative colloid usage,cholangiotomy and drainage or cholangiojejunostomy were independent risk factors for abdominal infection,while serum Alb was a protective factor(P<0.05).Hospitalization time of the infected group was longer than that of the non-infected group,and hospitalization cost of the infected group was higher than that of the non-infected group(P<0.05).The preoperative DBIL,ALT,and DBIL on the first day after operation in the infected group were higher than those in the non-infected group(P<0.05).There was no significant difference in 28-day mortality between the two groups(P>0.05).The levels of CRP,PCT,IL-6,and TNF-αin the infected group were higher than those in the non-infected group before operation and on the first and third day after operation(P<0.05).The area under the ROC curve(AUC)of mean CRP,PCT,IL-6,and TNF-αfor predicting abdominal infection within three days after operation were 0.821,0.817,0.813,and 0.772,respectively.Conclusion Age,diabetes,and operation time are influencing factors of abdominal infection after anatomical hepatectomy.The detection of CRP,PCT,IL-6,and TNF-αis of predictive value for early abdominal infection.
作者
何承峻
陈廷昊
彭强
王健宇
HE Chengjun;CHEN Tinghao;PENG Qiang;WANG Jianyu(Department of General Surgery,the First People's Hospital of Ziyang,Ziyang 641300,Sichuan,China)
出处
《贵州医科大学学报》
CAS
2024年第2期273-279,286,共8页
Journal of Guizhou Medical University
基金
四川省医学科研课题(S17083)。
关键词
解剖性肝切除术
腹腔感染
影响因素
血清指标
预测价值
anatomical hepatectomy
abdominal infection
influencing factor
serum indices
predictive value
