Analysis Of Influencing Factors Of Bacteremia In Endoscopic Treatment Of Esophageal And Gastric Varices In Patients With Cirrhosis

Objective: To investigate the bacteremia and its influencing factors after endoscopic treatment of esophageal and gastric variceal bleeding in patients with liver cirrhosis,in order to provide theoretical basis for the necessity of prophylactic use of antibiotics before and after endoscopic operation.Methods: Prospectively selected 200 with cirrhosis patients who underwent endoscopic treatment in the digestive endoscopy center of our hospital from January 1,2018 to August 1,2018 without any preoperative infection as the study subjects.Liver cirrhosis group was divided into ligation group and tissue glue plus sclerosing agent injection group according to endoscopic treatment methods;according to different anesthesia methods,they were divided into tracheal intubation anesthesia group and intravenous anesthesia group;according to the timing of endoscopic surgery,they were divided into elective operation group and emergency operation group;according to the number of puncture points during operation,they were divided into three groups,group A 1-4 points;group B,5-8 points;group C,9-14 points;each patient had one hour before operation and 12 Temperature,peripheral blood leukocytes,C-reactive protein(CRP),blood culture and drug sensitivity were measured within hours.The difference of body temperature,peripheral blood leukocyte,CRP and positive rate of blood culture in each group was analyzed and compared.It is also related to liver function classification,endoscopic treatment,timing of operation,number of puncture points during operation and anesthesia methods in patients with liver cirrhosis.Results: After endoscopic treatment,the body temperature,peripheral blood leukocyte and C-reactive protein levels and the positive rate of blood culture in patients with liver cirrhosis were significantly higher than those before operation(P<0.05).After endoscopic treatment,the body temperature,the level of C-reactive protein and the positive rate of blood culture in patients with Child-Pugh B and C were significantly higher than those in patients with Child-Pugh A(P<0.05).The body temperature,the level of C-reactive protein and the positive rate of blood culture in the tissue glue + sclerosing agent group were significantly higher than those in the ligation group(P<0.05),and the positive rate of blood culture in the tissue glue + sclerosing agent group was significantly higher than that in the ligation group(P<0.05).In intubation anesthesia group and intravenous anesthesia group,the body temperature,C-reactive protein level and positive rate of blood culture in intubation anesthesia group were higher than those in intravenous anesthesia group,the difference was statistically significant(P<0.05).In the patients with tissue glue + sclerosing agent injection as endoscopic treatment,the body temperature,C-reactive protein level and the positive rate of blood culture in group C(9 ~14 points)with a large number of puncture points were higher than those in groups A and B,and the positive rate of blood culture in group C was higher than that in group A and B.The difference was statistically significant(P<0.05).The postoperative body temperature,peripheral blood leukocyte,C-reactive protein level and positive rate of blood culture in the emergency operation group were significantly higher than those in the elective operation group(P<0.05).Conclusion: After endoscopic treatment of esophageal and gastric varices in patients with liver cirrhosis,bacteremia in Child-Pugh C grade,endoscopic tissue sclerosing agent injection treatment,especially in emergency surgery,trachea anesthesia and intraoperative puncture points are more likely to occur.Therefore,actively improving liver function,choosing appropriate operation mode,operation time and anesthesia mode,and reducing intraoperative puncture point as much as possible are the key links to reduce the occurrence of postoperative bacteremia.