Kyaw Moe H, Holmes Eileen M, Toolis Francis, Wayne Beverley, Chalmers Jim, Jones Ian G, Campbell Harry
Public Health Sciences, University of Edinburgh, Edinburgh, Scotland.
Am J Med. 2006 Mar;119(3):276.e1-7. doi: 10.1016/j.amjmed.2005.07.044.
Splenectomized patients are known to be at risk of severe infection, but the extent of risk is unclear. We evaluated the incidence of severe infection and survival in 1648 splenectomized patients.
Patients who underwent splenectomy between 1988 and 1999 in Scotland were identified through the Scottish hospital discharge records (SMR01) and then linked to the death certificate data recorded by the General Register Office in Scotland to obtain clinical and demographical information.
The overall rate of first severe infection was 7.0 per 100 person-years (95% confidence interval, 6.30-7.78). The overall rate for a second infection per 100 person-years was 44.9 and 109.3 for a third infection after the first episode of infection. Among the repeated episodes of severe infection, 42% to 76% and 61% to 84% of total episodes of second and third severe infection, respectively, occurred within 6 months after the first severe infection. The susceptibility to severe infection was greatest in older age groups (5.5 per 100 person-years in those aged > 50 years) and in patients splenectomized for hematologic malignancy (9.2), and iatrogenic splenectomy for malignancy disease (7.4). Between 50% and 80% of all severe infections or deaths occurred within 1 to 3 years after splenectomy.
The risk of severe infection is an important health problem in splenectomized patients, especially in those who underwent surgery for malignancies. Antibiotic prophylaxis could offer the most benefits in the first 3 years postsplenectomy or the first 6 months after the occurrence of a first severe infection.
已知脾切除患者有发生严重感染的风险，但风险程度尚不清楚。我们评估了1648例脾切除患者严重感染的发生率和生存率。
通过苏格兰医院出院记录（SMR01）识别1988年至1999年在苏格兰接受脾切除术的患者，然后将其与苏格兰总登记处记录的死亡证明数据相链接，以获取临床和人口统计学信息。
首次严重感染的总体发生率为每100人年7.0例（95%置信区间，6.30 - 7.78）。每100人年第二次感染的总体发生率为44.9例，第一次感染发作后第三次感染的总体发生率为109.3例。在严重感染的反复发作中，第二次和第三次严重感染的总发作次数分别有42%至76%和61%至84%发生在首次严重感染后的6个月内。严重感染的易感性在老年人群（年龄>50岁者每100人年5.5例）以及因血液系统恶性肿瘤行脾切除术的患者（9.2例）和因恶性疾病行医源性脾切除术的患者（7.4例）中最高。所有严重感染或死亡病例中有50%至80%发生在脾切除术后1至3年内。
严重感染风险是脾切除患者的一个重要健康问题，尤其是那些因恶性肿瘤接受手术的患者。抗生素预防在脾切除术后的前3年或首次严重感染发生后的前6个月可能最有益。
