论文部分内容阅读
目的 研究急性重症胆管炎(acute cholan gitis of severe type,ACST)伴严重血小板减少的病原菌构成及治疗.方法 入选2013年1月-2016年1月收住解放军总医院急诊重症监护室的22例急性重症胆管炎伴严重血小板减少患者的患者,分析其临床特征及病原学特点.结果 感染的病原菌包括大肠杆菌(31.81％)、肺炎克雷伯杆菌(50％)、铜绿假单胞菌(4.54％)、屎肠球菌(4.54％).22例中,出现血小板减少的天数在3～10d不等,在感染控制后血小板均明显回升.结论 胆道感染导致的血小板减少的病原菌以革兰氏阴性杆菌最为常见,肺炎克雷伯杆菌所占比例最大,大肠杆菌次之,但金黄色葡萄球菌等革兰氏阳性菌亦有上升趋势.血小板减少与疾病危重程度密切相关,及时有效的胆管引流及抗感染治疗才是关键,积极治疗血小板减少是治疗的有益补充.“,”Objective To analyze the pathogen of acute cholangitis of severe type (ACST) with severe thrombocytopenia and find the appropriate treating methods,we initiated our study.Methods 22 patients with acute severe cholangitis complicated with severe thrombocytopenia admitted to EICU from Jan.2013 to Jan.2016 of General Hospital of Chinese PLA were recruited,the clinical characteristics and culprit pathogens were analyzed.Results The culprit pathogens were Escherichia coli (31.81％),Klebsiella pneumoniae (50％),Pseudomonas aeruginosa (4.54％) and Enterococcus faecium (4.54％) randomly.The on-set time of severe thrombocytopenia occurred at about 3 to 10 days,with good results when infection was controled.Conclusion The culprit pathogen of biliary tract infection with severe thrombocytopenia was gram-negative bacilli at most.Of them,Klebsiella pneumoniae ranked the first,Escherichia coli was the second.Gram-positive bacteria such as Staphylococcus aureus were on the rise.The complication of thrombocytopenia was closely related to severity of the disease.Timely and effective treatment of bile duct drainage and appropriate antibiotics were the key point,and active treatment of thrombocytopenia was a useful supplement.