Effects of ultrasound-guided percutaneous catheter drainage on oxidative stress index and imaging characteristics in patients with bacterial liver abscess
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摘要:
目的 探讨超声引导下经皮穿刺置管引流术对细菌性肝脓肿患者氧化应激指标及影像学特征的影响。 方法 选取2018年10月~2021年7月于我院收治的细菌性肝脓肿患者70例，采用随机数字表法将患者分为对照组和观察组，35例/组。对照组行传统开腹脓肿切开引流术，观察组行超声引导下经皮穿刺置管引流术。比较观察组术前术后影像学表现，对比两组临床治疗效果，两组治疗前后氧化应激指标（丙二醛、超氧化物歧化酶、血清皮质醇）水平和并发症发生情况。 结果 观察组治疗总有效率高于对照组（97.14% vs 77.14%，P < 0.05）；影像学结果显示，术前肝区均可见混杂回声区且内部可见液性暗区，术中可见超声引导下穿刺针进入肝脓肿混杂回声区内，术后即刻可见液性暗区消失。观察组手术时间、引流时间、体温恢复时间、住院时间及白细胞数恢复正常时间均短于对照组（P < 0.05）；治疗前，两组超氧化物歧化酶、丙二醛、皮质醇水平差异无统计学意义（P>0.05）；治疗后，两组超氧化物歧化酶水平均升高，且观察组高于对照组（P < 0.05），两组丙二醛、皮质醇水平均下降，且观察组低于对照组（P < 0.05）；观察组术后胆瘘、脓气胸、伤口感染、肝内脓腔大出血及弥漫性腹膜炎等并发症总发生率明显低于对照组（20.00% vs 2.86%，P < 0.05）。 结论 细菌性肝脓肿患者经超声引导下经皮穿刺置管引流术治疗，疗效显著，且可有效改善血清氧化应激指标水平，且并发症发生率低。 Abstract:Objective To investigate the effects of ultrasound-guided percutaneous catheter drainage on oxidative stress index and imaging characteristics of patients with bacterial liver abscess. Methods Seventy patients with bacterial liver abscess in our hospital from October 2018 to July 2021 were selected. They were divided into control group (traditional open abscess incision and drainage) and observation group (ultrasound-guided percutaneous catheter drainage) using random number table method (n=35/group). The control group underwent traditional open abscess incision and drainage, while the observation group underwent ultrasound-guided percutaneous puncture and drainage. The preoperative and postoperative imaging manifestations of the observation group were compared as well as the clinical treatment results. The oxidative stress indicators (malondialdehyde, superoxide dismutase, serum cortisol) levels and the incidence of complications were compared between the two groups before and after treatment. Results The total effective rate of observation group was higher than control group (97.14% vs 77.14%, P < 0.05). Imaging results showed that there were mixed echo areas and liquid dark areas in the liver area before surgery, while the intraoperative and ultrasound guided puncture needles entered the mixed echo area of liver abscess during surgery, and liquid dark areas disappeared immediately after surgery. The operation, hospitalization and recovery time of indexes in the observation group were shorter than those in the control group (P < 0.05). Before treatment, there were no statistically significant differences in superoxide dismutase, malondialdehyde and cortisol levels between the two groups (P> 0.05). After treatment, superoxide dismutase level in both groups increased, and the observation group was higher than the control group (P < 0.05), malondialdehyde and cortisol levels decreased in both groups, and were lower in the observation group than in the control group (P < 0.05). The overall incidence of postoperative complications such as biliary fistula, pneumothorax, wound infection, hemorrhage from intrahepatic pus cavity and diffuse peritonitis in the observation group was significantly lower than that in the control group (20.00% vs 2.86%, P < 0.05). Conclusion Ultrasound-guided percutaneous catheter drainage is effective in the treatment of bacterial liver abscess, and can effectively improve the levels of serum oxidative stress index with a low complication rate. -
表 1 两组患者一般资料对比
Table 1. Comparison of two groups of general data (n=35)
组别 性别(n) 年龄
(岁, Mean±SD)脓肿直径
(cm, Mean±SD)男 女 对照组 19 16 51.8±9.3 7.44±1.35 观察组 21 14 50.1±8.6 7.41±1.26 χ2/t 0.230 0.794 0.096 P 0.629 0.430 0.924 
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表 2 两组疗效对比
Table 2. Comparison of clinical treatment effect between the two groups (n, n=35)
组别 治愈 显效 好转 无效 总有效率(%) 对照组 10 14 3 8 77.14 观察组 19 10 5 1 97.14 χ2 6.250 P 0.012
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表 3 两组手术指标对比
Table 3. Comparison of surgical indicators between the two groups (n=35, Mean±SD)
组别 手术时间(min) 引流时间(d) 体温恢复时间(d) 住院时间(d) 白细胞数恢复正常时间(d) 对照组 95.6±14.2 10.5±1.6 4.6±0.7 12.0±3.1 7.4±1.2 观察组 30.5±5.1 6.2±1.1 3.1±0.5 9.8±2.2 2.8±0.5 t 25.526 13.102 10.316 3.424 20.934 P < 0.001 < 0.001 < 0.001 0.001 < 0.001
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表 4 两组氧化应激指标比较
Table 4. Comparison of oxidative stress indexes between the two groups (n=35, Mean±SD)
指标 时间 对照组 观察组 t P SOD(U/mL) 治疗前 75.21±11.09 74.89±10.96 0.121 0.904 治疗后 112.75±16.82* 133.23±19.96* 4.642 < 0.001 MDA(mmol/mL) 治疗前 7.33±1.02 7.39±1.08 0.239 0.812 治疗后 6.09±0.87* 4.29±0.62* 9.968 < 0.001 Cor(nmol/mL) 治疗前 137.03±15.02 137.39±15.10 0.100 0.921 治疗后 121.29±13.87* 110.53±12.62* 3.395 0.001 *P < 0.05 vs治疗前; SOD: 超氧化物歧化酶; MDA: 丙二醛; Cor: 皮质醇.
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表 5 两组并发症发生情况比较
Table 5. Comparison of complications between the two groups[n=35, n(%)]
组别 胆瘘 脓气胸 伤口感染 肝内脓腔大出血 弥漫性腹膜炎 总发生率 对照组 0 (0.00) 0 (0.00) 1 (2.86) 0 (0.00) 0 (0.00) 1 (2.86) 观察组 2 (5.71) 1 (2.86) 2 (5.71) 1 (2.86) 1 (2.86) 7 (20.00) χ2 5.080 P 0.024
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