影响抗生素成功治疗腹腔脓肿的因素和经皮穿刺引流的必要性

作     者：Kumar R. R. Kim J. T. Haukoos J. S. 纪泛扑(译) 史敏(校) 

作者机构：Division of Colon and Rectal Surgery Harbor-UCLA Medical Center Box 25 1000 West Carson Street Torrance CA 90509 United States 不详 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第8期

页      面：8-9页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 100204[医学-神经病学] 10[医学] 

主　　题：经皮穿刺引流 抗生素治疗 腹腔脓肿 治疗方案 影像学引导 Fisher 人口统计学 抗生素作用 X^2检验 治疗效果 

摘      要：PURPOSE: There is no definite consensus on the management of intra-abdominal Abscesses in adults. This retrospective study evaluated the use of antibiotic therapy and percutaneous image-guided drainage in adult patients with intra-abdominal Abscesses. METHODS: A retrospective chart review of 114 patients with intra-abdominal Abscesses was conducted. Data collected included patient demographics, presenting symptoms, radiographic interpretation, vital signs, antibiotic coverage, laboratory values, and details of the hospital course. Bivariate statistical tests were performed using the Wilcoxon rank-sum test, chi-squared test, or Fisher s exact test, where appropriate. RESULTS: Sixty-seven of 114 patients (59 percent) had intra-abdominal Abscesses resulting from appendicitis, diverticulitis in 30 patients (26 percent), postoperative in 13 patients (11 percent), and undetermined in 4 patients (4 percent). Three patients (3 percent; 95 percent confidence interval, 1- 8 percent) failed conservative management and underwent urgent operation. Sixty-one (54 percent; 95 percent confidence interval, 44- 63 percent) patients improved with intravenous antibiotic therapy alone. Fifty patients (44 percent; 95 percent confidence interval, 35- 54 percent) underwent image-guided percutaneous drainage after 48 to 72 hours of antibiotic therapy. Patients who improved on antibiotics alone had average Abscess diameter of 4 cm, whereas patients who underwent percutaneous drainage had average diameter of 6.5 cm (P 6.5 cm and temperature at admission 101.2° F have higher likelihood of failing conservative therapy with antibiotics alone and requiring percutaneous drainage.