CT引导下经皮肾穿刺活检患者医院感染影响因素分析
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摘要
目的分析电子计算机断层扫描(Computed Tomography,CT)引导下经皮肾穿刺活检患者发生医院感染的影响因素。方法选择2015年2月-2017年5月于医院行肾穿刺活检术的患者150例为研究对象,均行CT引导下经皮肾穿刺活检术。分析患者年龄,病灶大小,穿针次数,进针深度等临床资料,归纳CT引导下经皮肾穿刺活检患者医院感染的影响因素。结果 CT引导下经皮肾穿刺活检患者经治疗后,出现气胸、出血29例,发生率为19.33%;出现感染30例,感染率为20.00%(30/150),感染部位以呼吸道为主;共培养分离病原菌28株,其中革兰阴性菌14株占50.00%,革兰阳性菌12株占42.86%;年龄,穿刺次数及合并慢性阻塞性肺疾病是经皮肾穿刺患者术后感染的影响因素(P<0.05)。结论高龄、合并有基础疾病及多次穿刺的患者在行CT引导下经皮肾脏穿刺术后应高度重视,特别是呼吸道感染,应及时进行预防,以降低感染率。
OBJECTIVE To analyze the risk factors of nosocomial infection in patients undergoing percutaneous renal biopsy under guidance of Computed Tomography(CT). METHODS 150 cases of patients undergoing renal biopsy in the hospital from Feb. 2015 to May 2017 were selected as the research objects, and all underwent percutaneous renal biopsy under CT guidance. The clinical data of the patients such as age, lesion size, frequency of puncture, and puncture depth, and the influencing factors of nosocomial infection in patients undergoing CT-guided percutaneous renal biopsy were summarized. RESULTS After treatment, pneumothorax and bleeding occurred in 29 patients undergoing CT-guided percutaneous renal biopsy, and the incidence was 19.33%. There were 30 cases of infection, with an infection rate of 20.00%(30/150), and the infection site was dominated by the respiratory tract. A total of 28 strains of pathogens were isolated, including 14 strains of Gram-negative strains(50.00%), and 12 strains of Gram-positive bacteria(42.86%). Age, puncture frequency and chronic obstructive pulmonary disease were the influencing factors of infection after percutaneous nephrectomy(P<0.05). CONCLUSION Patients with old age, underlying diseases and repeated puncture should be paid great attention after CT-guided percutaneous renal puncture. In particular, respiratory infection should be prevented in a timely manner, so as to reduce the infection rate.
OBJECTIVE To analyze the risk factors of nosocomial infection in patients undergoing percutaneous renal biopsy under guidance of Computed Tomography(CT). METHODS 150 cases of patients undergoing renal biopsy in the hospital from Feb. 2015 to May 2017 were selected as the research objects, and all underwent percutaneous renal biopsy under CT guidance. The clinical data of the patients such as age, lesion size, frequency of puncture, and puncture depth, and the influencing factors of nosocomial infection in patients undergoing CT-guided percutaneous renal biopsy were summarized. RESULTS After treatment, pneumothorax and bleeding occurred in 29 patients undergoing CT-guided percutaneous renal biopsy, and the incidence was 19.33%. There were 30 cases of infection, with an infection rate of 20.00%(30/150), and the infection site was dominated by the respiratory tract. A total of 28 strains of pathogens were isolated, including 14 strains of Gram-negative strains(50.00%), and 12 strains of Gram-positive bacteria(42.86%). Age, puncture frequency and chronic obstructive pulmonary disease were the influencing factors of infection after percutaneous nephrectomy(P<0.05). CONCLUSION Patients with old age, underlying diseases and repeated puncture should be paid great attention after CT-guided percutaneous renal puncture. In particular, respiratory infection should be prevented in a timely manner, so as to reduce the infection rate.
引文
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[22] 徐永通,张海静,冯涛,等.肾穿刺活检术后血肿感染危险因素分析[J].中华医院感染学杂志,2017,27(11):2498-2501.
[23] Wagenlehner FM,Weidner W,Naber KG.Antibiotics in urology - new essentials[J].Urol Clin North Am,2008,35(1):69-79.
[24] 黄恒洁,谭耀英,陈万莉,等.超声引导下肾穿刺活检术后不同护理方法的临床效果[J].微创医学,2013,8(3):383-384.
[25] 李晓,陈新晖,徐爱民,等.CT导向经皮肾穿刺造瘘的临床应用[J].放射学实践,2014,29(3):323-325.
[26] 陈雨,徐丽,陈军等.外科重症监护病房感染耐碳青霉烯类肺炎克雷伯菌的危险因素分析[J].中国血液流变学杂志,2018,28(2):161-165.
[2] Davis IC,Heilbrun ME,Tangtiang K,et al.Computed tomography-guided renal tumor biopsies:tumor imaging features affecting sample adequacy[J].J Comput Assist Tomogr.2013,37(2):171-175.
[3] Kapoor BS,Esparaz A,Levitin A,et al.Nonvascular and portal vein applications of cone-beam computed tomography:current status[J].Tech Vasc Interv Radiol,2013,16(3):150-160.
[4] 赵军,杨瑞青.CT引导下经皮穿刺活检对肺部疾病的诊断价值[J].中华全科医学,2014,12(9):1400-1402,1443.
[5] Raman JD.Percutaneous renal biopsy may aid management of small renal masses on active surveillance[J].Can J Urol,2013,20(2):6742-6742.
[6] Jie C,Kai-Zhi L.Use of propofol for pediatric percutaneous renal needle biopsy:164 cases of experience[J].Indian J Pediatr,2013,80(12):1062.
[7] Connolly SS,Koo B,Warren AY,et al.Modern myths of percutaneous renal tumour mass biopsy[J].BJU Int,2015,115(1):8-9.
[8] Huang SY,Ahrar K,Gupta S,et al.Safety and diagnostic accuracy of percutaneous biopsy in upper tract urothelial carcinoma[J].BJU Int,2015,115(4):625-632.
[9] Ziad F,Ninin D,Graham L.Intraglomerular tubular epithelial cell emboli - case report of a rare percutaneous needle biopsy artefact[J].Nephrology (Carlton),2013,18(2):158-159.
[10] 韩敏,芮昱雯,苏欣,等.云南白药胶囊对经皮肺穿刺活检术后出血情况及炎性反应、应激反应的影响[J].安徽医药,2016,20(11):2147-2149,2150.
[11] Hofmann M,Pflanzer R,Habib A,et al.Scanning acoustic microscopy-a novel noninvasive method to determine tumor interstitial fluid pressure in a xenograft tumor model [J].Transl Oncol,2016,9(3):179-183.
[12] 宫瑞红,胡丹.B超引导下行经皮肾穿刺活检术围手术期护理[J].饮食保健,2015,2(16):98-99.
[13] Eiro M,Katoh T,Watanabe T.Risk factors for bleeding complicationsin percutaneous renal biopsy[J].Clin Exp Nephrol,2005,9(1):40-45.
[14] Horcicka V Jr,Krejcí K,Zadrazil J,et al.Arteriovenous fistula as acomplication of renal biopsy[J] .Vnitr Lek,2002,48(5):432-437.
[15] 华锦程,许树根,胡玉清,等.老年肾病患者经皮肾穿刺活检术的临床病理分析及安全性评估[J].东南国防医药,2017,19(4):361-364.
[16] Ishikawa E,Nomura S,Hamaguchi T,et al.Ultrasonography as apredictor of overt bleeding after renal biopsy[J].Clin Exp Nephrol,2009,13(4):325-331.
[17] Daishi H,Shuichiro F,Naoto N,et al.Role of ultrasound in revealing complications following percutaneous renal biopsy in children[J].Clin Nephrol,2013,80(6):426-432.
[18] Felker ER,Lee-Felker SA,Alpern L,et al.Efficacy of imaging-guided percutaneous radiofrequency ablation for the treatment of biopsy-proven malignant cystic renal masses[J].AJR Am J Roentgenol,2013,201(5):1029-1035.
[19] Sainani NI,Tatli S,Anthony SG,et al.Successful percutaneous radiologic management of renal cell carcinoma tumor seeding caused by percutaneous biopsy performed before ablation[J].J Vasc Interv Radiol,2013,24(9):1404-1408.
[20] Xie Y,Ge QM,Bian F.Successful interventional treatment of arteriovenous fistula complicating percutaneous renal biopsy[J].Vasa,2013,42(2):149-152.
[21] Hu R,Montemayor-Garcia C,Das K.Role of percutaneous needle core biopsy in diagnosis and clinical management of renal.masses[J].Hum Pathol,2015,46(4):570-576.
[22] 徐永通,张海静,冯涛,等.肾穿刺活检术后血肿感染危险因素分析[J].中华医院感染学杂志,2017,27(11):2498-2501.
[23] Wagenlehner FM,Weidner W,Naber KG.Antibiotics in urology - new essentials[J].Urol Clin North Am,2008,35(1):69-79.
[24] 黄恒洁,谭耀英,陈万莉,等.超声引导下肾穿刺活检术后不同护理方法的临床效果[J].微创医学,2013,8(3):383-384.
[25] 李晓,陈新晖,徐爱民,等.CT导向经皮肾穿刺造瘘的临床应用[J].放射学实践,2014,29(3):323-325.
[26] 陈雨,徐丽,陈军等.外科重症监护病房感染耐碳青霉烯类肺炎克雷伯菌的危险因素分析[J].中国血液流变学杂志,2018,28(2):161-165.