69例细菌性肝脓肿的临床特征分析
|
摘要
目的总结分析细菌性肝脓肿的临床特征,为合理诊疗提供依据。方法回顾性分析2015年1月～2017年12月我院收治的69例细菌性肝脓肿的临床病例资料,并对其进行描述性研究。结果患者平均年龄(56.53±12.88)岁,发病的最高峰年龄为50～69岁(59.42%)。有58例患者存在1或多种基础疾病,合并糖尿病者最多(32例,46.38%)。肝脓肿患者最主要的临床表现是发热(62例,89.86%),其次是畏寒寒战(42例,60.87%)和右上腹疼痛(29例,40.03%)。患者中以单腔肝右叶脓肿居多(52例,75.36%)。实验室检查异常指标中中性粒细胞百分比升高和清蛋白降低最为显著,分别为64例(92.75%)和54例(78.26%)。24例患者行血培养,15例阳性(62.50%)。36例患者行穿刺脓液细菌学培养,29例阳性(80.56%)。5例患者的血培养及穿刺脓液培养结果均为肺炎克雷伯杆菌。治疗方式以抗菌药物联合经皮穿刺置管引流为主。40例患者治愈,26例患者好转,总有效率为95.65%。结论细菌性肝脓肿好发于中老年人,主要的临床表现为高热、畏寒寒战、右上腹疼痛,主要的病原菌是肺炎克雷伯杆菌。完善腹部彩超及上腹部CT可协助细菌性肝脓肿的早期诊断。
Objective To summarize and analyze the clinical features of bacterial liver abscess and provide evidence for rational diagnosis and treatment. Methods The clinical data of 69 cases patients with bacterial liver abscess treated in our hospital from January 2015 to December 2017 were retrospectively analyzed and descriptively studied. Results The average age of patients was(56.53±12.88) years old. The highest peak age of bacterial liver abscess onset was 50-69 years old(59.42%). There were 58 patients with one or more underlying diseases and mostly complicated with diabetes mellitus(n=32, 46.38%). The main clinical manifestations of patients with liver abscess were fever(n=62, 89.86%),followed by fear of cold and chills(n=42, 60.87%) and right upper quadrant pain(n=29, 40.03%). Among the patients,single-lumen right lobe abscess was common(n=52, 75.36%). The percentages of neutrophils increase and albumin reduction were the most remarkable in laboratory abnormalities, 92.75%(64/69) and 78.26%(54/69), respectively. Twenty-four patients underwent blood culture and 15 were positive(62.50%). Thirty-six patients underwent bacteriological culture from pus puncturing and 29 were positive(80.56%). The blood culture and pus culture results were Klebsiella pneumonia in 5 patients. The treatment method is mainly based on antibacterial drugs combined with percutaneous puncture drainage. Forty patients were cured and 26 ones were improved, with a total effectiveness rate of 95.65%.Conclusion Bacterial liver abscess occurs in middle-aged and elderly people. The main clinical manifestations are high fever, fear of cold and chills, right upper quadrant pain. The main pathogen is Klebsiella pneumoniae. Perfect abdominal color Doppler ultrasound and upper abdominal CT can assist in the early diagnosis of bacterial liver abscess.
Objective To summarize and analyze the clinical features of bacterial liver abscess and provide evidence for rational diagnosis and treatment. Methods The clinical data of 69 cases patients with bacterial liver abscess treated in our hospital from January 2015 to December 2017 were retrospectively analyzed and descriptively studied. Results The average age of patients was(56.53±12.88) years old. The highest peak age of bacterial liver abscess onset was 50-69 years old(59.42%). There were 58 patients with one or more underlying diseases and mostly complicated with diabetes mellitus(n=32, 46.38%). The main clinical manifestations of patients with liver abscess were fever(n=62, 89.86%),followed by fear of cold and chills(n=42, 60.87%) and right upper quadrant pain(n=29, 40.03%). Among the patients,single-lumen right lobe abscess was common(n=52, 75.36%). The percentages of neutrophils increase and albumin reduction were the most remarkable in laboratory abnormalities, 92.75%(64/69) and 78.26%(54/69), respectively. Twenty-four patients underwent blood culture and 15 were positive(62.50%). Thirty-six patients underwent bacteriological culture from pus puncturing and 29 were positive(80.56%). The blood culture and pus culture results were Klebsiella pneumonia in 5 patients. The treatment method is mainly based on antibacterial drugs combined with percutaneous puncture drainage. Forty patients were cured and 26 ones were improved, with a total effectiveness rate of 95.65%.Conclusion Bacterial liver abscess occurs in middle-aged and elderly people. The main clinical manifestations are high fever, fear of cold and chills, right upper quadrant pain. The main pathogen is Klebsiella pneumoniae. Perfect abdominal color Doppler ultrasound and upper abdominal CT can assist in the early diagnosis of bacterial liver abscess.
引文
[1]郭辉,田力.细菌性肝脓肿伴糖尿病70例临床分析[J].中国实验诊断学,2014,18(5):852-853.
[2]肖红菊,申晓东,翟永志,等.以不明原因发热为表现的细菌性肝脓肿96例临床病例分析[J].解放军医学院学报,2014,35(12):1185-1187,1274.
[3]李婧,符颖,王吉耀,等.肺炎克雷伯菌肝脓肿的临床及影像学特征[J].中华消化杂志,2010,30(4):230-235.
[4]Pastagia M,Arumugam V.Klebsiella pneumoniae liver abscesses in a public hospital in Queens,New York[J].Travel Med Infect Dis,2008,6(4):228-233.
[5]Lin YT,Siu LK,Lin JC,et al.Seroepidemiology of klebsiella pneumoniae c olonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries[J].BMC Microbiol,2012,12(10):13-20.
[6]吴孟超,吴在德,黄家驷.外科学[M].7版.北京:人民卫生出版社,2008:1685.
[7]吴在德,吴肇汉.外科学[M].7版.北京:人民卫生出版社,2010:514-516.
[8]郑萍.彩色多普勒引导下经皮肝穿刺置管引流治疗细菌性肝脓肿[J].泰山医学院学报,2014,35(2):146-147.
[9]王伟芳,韩明子,金世柱,等.细菌性肝脓肿临床特点的回顾性分析[J].现代生物医学进展,2016,16(7):1276-1280.
[10]Morii K,Kashihara A,Miuraetal S.Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae[J].Clin J Gastroenterol,2012,5(2):136-140.
[11]刘真真,熊亚莉,卢家桀,等.267例细菌性肝脓肿患者的临床表现及病原学分析[J].临床内科杂志,2006,23(7):464-466.
[12]李晓晶,汪波,熊辉.糖尿病合并肝脓肿的临床特点及其感染细菌分布[J].中国临床药理学杂志,2015,31(3):232-234.
[13]邵亚丽.糖尿病合并肝脓肿的临床特征[J].肝脏,2017,22(2):143-146.
[14]马杰,彭心宇,吴向未,等.2型糖尿病合并细菌性肝脓肿的临床特征研究[J].中国全科医学,2014,12(34):4093.
[15]李登云,杨利萍,姜新华,等.肝脓肿合并糖尿病患者感染病原菌分布及药敏分析[J].中华医院感染学杂志,2017,27(22):5116-5118.
[16]周薇,黄文芳.高毒力肺炎克雷伯菌的研究进展[J].中国感染与化疗杂志,2016,16(6):800-803.
[17]刘波,丁炎,王爱花,等.不同糖化血红蛋白控制水平糖尿病并发肺炎克雷伯杆菌肝脓肿患者的临床和影像学表现[J].中国全科医学,2016,18(23):2840-2844.
[18]刘心,周俊林刘婷,等.超声造影和增强CT对肝血管瘤的诊断价值比较[J].实用放射学杂志,2012,28(1):61-64.
[19]李美琳,王仲,杜铁宽,等.肝脓肿临床特点及抗菌药物的治疗策略(附58例分析)[J].临床误诊误治,2014,27(1):77-79.
[2]肖红菊,申晓东,翟永志,等.以不明原因发热为表现的细菌性肝脓肿96例临床病例分析[J].解放军医学院学报,2014,35(12):1185-1187,1274.
[3]李婧,符颖,王吉耀,等.肺炎克雷伯菌肝脓肿的临床及影像学特征[J].中华消化杂志,2010,30(4):230-235.
[4]Pastagia M,Arumugam V.Klebsiella pneumoniae liver abscesses in a public hospital in Queens,New York[J].Travel Med Infect Dis,2008,6(4):228-233.
[5]Lin YT,Siu LK,Lin JC,et al.Seroepidemiology of klebsiella pneumoniae c olonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries[J].BMC Microbiol,2012,12(10):13-20.
[6]吴孟超,吴在德,黄家驷.外科学[M].7版.北京:人民卫生出版社,2008:1685.
[7]吴在德,吴肇汉.外科学[M].7版.北京:人民卫生出版社,2010:514-516.
[8]郑萍.彩色多普勒引导下经皮肝穿刺置管引流治疗细菌性肝脓肿[J].泰山医学院学报,2014,35(2):146-147.
[9]王伟芳,韩明子,金世柱,等.细菌性肝脓肿临床特点的回顾性分析[J].现代生物医学进展,2016,16(7):1276-1280.
[10]Morii K,Kashihara A,Miuraetal S.Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae[J].Clin J Gastroenterol,2012,5(2):136-140.
[11]刘真真,熊亚莉,卢家桀,等.267例细菌性肝脓肿患者的临床表现及病原学分析[J].临床内科杂志,2006,23(7):464-466.
[12]李晓晶,汪波,熊辉.糖尿病合并肝脓肿的临床特点及其感染细菌分布[J].中国临床药理学杂志,2015,31(3):232-234.
[13]邵亚丽.糖尿病合并肝脓肿的临床特征[J].肝脏,2017,22(2):143-146.
[14]马杰,彭心宇,吴向未,等.2型糖尿病合并细菌性肝脓肿的临床特征研究[J].中国全科医学,2014,12(34):4093.
[15]李登云,杨利萍,姜新华,等.肝脓肿合并糖尿病患者感染病原菌分布及药敏分析[J].中华医院感染学杂志,2017,27(22):5116-5118.
[16]周薇,黄文芳.高毒力肺炎克雷伯菌的研究进展[J].中国感染与化疗杂志,2016,16(6):800-803.
[17]刘波,丁炎,王爱花,等.不同糖化血红蛋白控制水平糖尿病并发肺炎克雷伯杆菌肝脓肿患者的临床和影像学表现[J].中国全科医学,2016,18(23):2840-2844.
[18]刘心,周俊林刘婷,等.超声造影和增强CT对肝血管瘤的诊断价值比较[J].实用放射学杂志,2012,28(1):61-64.
[19]李美琳,王仲,杜铁宽,等.肝脓肿临床特点及抗菌药物的治疗策略(附58例分析)[J].临床误诊误治,2014,27(1):77-79.