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目的探究肝动脉栓塞术(TACE)和颈静脉肝内门体分流术(TIPS)在围手术期应用抗菌药物对术后感染的预防评价,为术后患者合理用药提供依据。方法分析2010年2月-2015年1月医院行TACE和TIPS治疗的肝硬化患者的临床资料,按照是否使用抗菌药物分组,其中252例行TACE,抗菌药物组158例,非抗菌药物组70例;138例行TIPS患者抗菌药物组98例,非抗菌药物组40例;观察患者术后是否发生感染,并对术后感染进行单因素及多因素logistic回归分析。结果行TACE和TIPS患者抗菌药物组和非抗菌药物组术后感染率差异无统计学意义;单因素分析发现,年龄、Child-Pugh分级、手术时间、肿瘤大小与TACE和TIPS术后感染有关,差异均有统计学意义(P<0.05);以术后是否发生感染为因变量,进行多因素logistic分析,结果显示,年龄、Child-Pugh分级、手术时间、肿瘤大小是行TACE和TIPS患者术后感染的危险因素。结论 TACE和TIPS在围手术期应用抗菌药物的意义不大,但对于年龄大、肝功能严重异常、手术时间长、肿瘤大的患者,应给予抗菌药物进行预防术后感染。
Objective To investigate the preventive and therapeutic evaluation of perioperative antibiotics on postoperative infection by transcatheter arterial chemoembolization (TACE) and jugular vein endotracheal shunt (TIPS) in order to provide basis for rational use of drugs in postoperative patients. Methods Clinical data of patients with cirrhosis treated with TACE and TIPS from February 2010 to January 2015 were analyzed retrospectively. TACE was performed in 252 patients, 158 patients in antibacterial drug group, 70 patients in non-antibacterial drug group, ; 138 patients with TIPS antibacterial drug group of 98 patients, non-antibacterial drug group of 40 patients; observed patients with postoperative infection, and postoperative infection by univariate and multivariate logistic regression analysis. Results There was no significant difference in postoperative infection rates between TACE and TIPS patients in antibacterial and non-antibacterial groups. Univariate analysis showed that age, Child-Pugh classification, operation time and tumor size were related to TACE and TIPS postoperative infection, Multivariate logistic analysis showed that age, Child-Pugh grading, operation time and tumor size were performed in patients undergoing TACE and TIPS surgery (P <0.05) .According to multivariate logistic analysis, Risk factors for post-infection. Conclusion TACE and TIPS have little significance in perioperative application of antimicrobial agents. However, for patients with large age, severe liver dysfunction, long operation time and large tumor size, antimicrobial agents should be given to prevent postoperative infection.