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重庆医科大学附属第一医院泌尿外科
纸质出版日期:2010,
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[1]汤召兵,苟欣,王明,刘朝东,何卫阳.上尿路梗阻术后继发铜绿假单胞菌感染的治疗策略[J].重庆医科大学学报,2010,35(07):1105-1108.
TANG Zhao-bing, et al. Management of upper urinary tract infections caused by pseudomonas aeruginosa after operation of upper urinary tract obstruction[J]. Journal of Chongqing Medical University, 2010,35(7):1105-1108.
[1]汤召兵,苟欣,王明,刘朝东,何卫阳.上尿路梗阻术后继发铜绿假单胞菌感染的治疗策略[J].重庆医科大学学报,2010,35(07):1105-1108. DOI: 10.13406/j.cnki.cyxb.2010.07.021.
TANG Zhao-bing, et al. Management of upper urinary tract infections caused by pseudomonas aeruginosa after operation of upper urinary tract obstruction[J]. Journal of Chongqing Medical University, 2010,35(7):1105-1108. DOI: 10.13406/j.cnki.cyxb.2010.07.021.
目的:探索上尿路梗阻手术治疗置入双J管后继发铜绿假单胞菌(Pseudomonas aeruginosa
PA)感染的有效治疗方案。方法:2004年3月至2009年5月我科收治的因上尿路梗阻手术治疗置入双J管后铜绿假单胞菌感染30例病人
所有患者术前都曾做逆行造影检查;术后双J管留置时间≥2周
术后继发尿路感染
尿培养出PA、菌落计数>10万。按入院顺序将病人随机分成A、B两组
A组治疗方案:再次或继续留置双J管+敏感抗生素治疗2周
拔除双J管
停药1周作尿培养
如感染未完全控制
尿培养阳性
再根据药敏选择敏感抗生素治疗2周
如此进行共3个疗程。B组治疗方案:重新放置进口双J管(美国Cook
F6)
选择敏感抗生素染治疗2周
停药1周作尿培养
如感染未完全控制
尿培养阳性
再根据药敏选择敏感抗生素治疗2周
如此重复进行直到感染完全治愈后拔除双J管。结果:A组
再留置双J管时间2周
抗生素使用第1个疗程(2周)治愈4例(占26.7%)
第2疗程治愈2例(两个疗程共治愈6例
占40%)
第3疗程治愈1例(3个疗程共治愈7例
占46.7%)。B组
再留置双J管时间4~12周(平均8周);第1个疗程治愈3例(占20%)
第2疗程治愈9例(2个疗程共治愈12例
占80%)
第3疗程治愈2例(前3疗程治愈率93.3%)
两个疗程及3个疗程后的总治愈率
A组与B组间差异非常显著(P<0.05)
B组明显优于A组。结论:对于上尿路梗阻手术治疗置入双J管继发铜绿假单胞菌感染的治疗
较长时间留置双J管+敏感抗生素治疗、感染治愈后才拔除双J管(B组方案)的临床疗效明显优于双J管留置2周+敏感抗生素治疗(A组方案)。前者是值得在临床上推荐使用的有效治疗方法。
Objective:To explore the management ofupper urinarytract infections caused pseudomonas aeruginosa after operation ofupper urinary tract obstruction.Methods:A total of 30 cases with upper urinary tract obstruction
which had undergone pyeloureteroplasty or lithonephrotomy and been placed double-J tubes intraoperatively and been infected by pseudomonas aeruginosa
were treated from March 2004 to May 2009.They had undergone retrograde urography before operation
double-J tube were retained for 2 weeks or more postoperatively;PA were isolated by urine culture and colony count>1×105/ml。These cases were assigned to A or B group randomly.The management of A group:double-J tubes were placed and retained for 2 weeks again
and used susceptible antibiotics for 2 weeks→ discontinued drugs for 1 week→urine cultured
PA(+)→used susceptible antibiotics for 2 weeks→discontinued drugs for 1 week→urine cultured
PA(+)→used susceptible antibiotics for 2 weeks;the management of B group:double-J tube(sCook
F6
America)were placed again
and used susceptible antibiotics for 2 weeks→discontinued drugs for 1 week→urine cultured
PA(+)→used susceptible antibiotics for 2 weeks
until the infection was cured
the double-J tube was removed after the infection was cured.Results:A group:double-J tubes were retained for 2 weeks additionally;4 patients were cured during the first two-week
2 patients were cured during the second two-week
the cure rate was 40%after two courses
one was cured during the third two-week
the cure rate was 46.7%after three courses.B group:double-J tubes was retained for 4~12 weeks(mean 8 weeks)additionally
3 patients were cured during the first two-week
9 patients were cured during the second two-week
the cure rate was 80%after two courses
2 patients were cured during the third two-week
the cure rate was 93.3%after three courses.The cure rate ofBgroup was significantlyhigher than Agroup after twocourses and three courses
the difference was significan(tP<0.05). Conclusion:The therapeutic effect on upper urinary tract infectionts caused by pseudomonas aeruginosa after operation of upper urinary tract obstruction
ofBtreatment perscription—double-J tube(sCook
F6
America)was placed again and used susceptible antibiotics
the double-J tube was removed after the infection was cured—was significantly better than that of A treatment pescription—double-J tubes was placed and retained for 2 weeks again
and used susceptible antibiotics.The former was an effective method
it is worth tospread clinically.
上尿路梗阻双J管铜绿假单胞菌尿路感染
Upper urinary tract obstructionDouble-J tubePseudomonas aeruginosaUrinary tract infection
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