摘要
目的探讨肝脏外伤并发腹腔感染的诊治方法,以期为肝脏外伤并发腹腔感染的预防治疗起到指导作用。方法回顾性分析医院2000年1月-2012年9月64例肝脏外伤患者的临床资料,其中7例行保守治疗,57例行手术治疗,均予预防性抗感染、保肝、营养等治疗方法。结果 64例患者中23例出现腹腔感染,感染率为35.9%,其中单纯性肝脏外伤患者无并发腹腔感染,合并胃肠道损伤的肝脏外伤患者中并发腹腔感染率为85.7%,AAST IV级患者中腹腔感染率为51.5%;共培养出病原菌41株,其中,位居前3位的病原菌分别是大肠埃希菌15株占36.6%、粪肠球菌10株占24.4%、屎肠球菌8株占19.5%;23例腹腔感染患者中,22例治愈,治愈率为95.65%。结论复杂肝脏外伤尤其是合并多脏器损伤的患者较易并发腹腔感染,采用损伤控制外科理念、微创手术、综合治疗等措施可有效控制和治疗感染,降低患者的死亡率。
OBJECTIVE To explore the measures for diagnosis and treatment of liver trauma complicated with intra- abdominal infections so as to guide the prevention and treatment of intra-abdominal infections. METHODS We retrospectively analyzed the clinical data of 64 patients with liver trauma between Jan 2000 and Sep 2012, including 7 cases of conservative treatment and 57 cases of surgical treatment, and all the cases were treated with prevention of infections, liver protection, and nutritional support. RESULTS Of the 64 cases of patients, there were 23 cases of peritoneal infections with the infection rate of 35.9 %. No simple liver trauma patients suffered from complica- ting intrabdominal infection, while among the patients with gastrointestinal trauma the incidence of peritoneal in- fections was 85.7%, and the incidence of the patients with the AAST grading IV was 51.5%. Totally 41 strains of pathogens were isolated, among which there were 15 （36.6%） strains of Escherichia co li, 10 （24.4 %） strains of Enterococcus faecalis, and 8 （19.5%） strains of Enterococcus faecium, which ranked the top three species of the pathogens. Of totally 23 cases of patients with peritoneal infections, 22 cases were cured with the cure rate of 95.65 %. CONCLUSION The incidence of intraabdominal infections is high in the patients with complex liver trau- ma, especially the patients with multi-organ trauma. The integrated treatment with micro-invasive operations on the basis of trauma-control surgery idea can effectively cure the intraahdominal infections and decrease the mortality.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第12期2883-2885,共3页
Chinese Journal of Nosocomiology
基金
全军医学科学技术研究"十二五"计划(CWS11J096)
关键词
肝脏外伤
腹腔感染
细菌培养
Liver trauma
Intraabdominal infection
Bacterial culture
