重型肝炎患者并发医院真菌感染相关因素的研究  

Clinical study on the severe hepatitis with nosocomial fungal infections and risk factors

作　　者：张学海[1] 张光海[1] 满昌军[1] 何方鸣 

机构地区：[1]济宁市传染病医院,山东272031

出　　处：《中华肝脏病杂志》2004年第7期389-391,共3页Chinese Journal of Hepatology

基　　金：济宁市科技局科研基金(200128)

摘　　要：目的 了解重型肝炎(简称重肝)患者并发医院真菌感染的相关因素。方法 对1997年2月～2002年6月住院重肝并发真菌感染患者进行前瞻性研究。结果 115例重肝并发真菌感染患者平均(37.2±21.5)岁;其中男49例,女66例。主要感染部位为腹腔(40.9％),呼吸道(26.9％),消化道(21.8％)。感染菌种以白色念珠菌为主,占67.6％。其感染因素为使用广谱抗生素和激素、白细胞减少、疾病严重程度、侵袭性诊疗操作。研究组与同期无真菌感染的重肝患者(对照组)比较:病死率分别为59.1％(68/115)和34.8％(40/115),两组治疗无效的病例(恶化和死亡病例)比较差异有显著性,x^2=36.0,P<0.001。多变最分析发现白细胞减少、感染播散和疾病严重程度是影响预后的因素。结论 重肝并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。Objective To study the nosocomial fungal infections in the patient with severe hepatitis and analyze of risk factor. Methods All 115 severe hepatitis with fungal infections inpatients was studied prospectively. Results We identified 115 cases with fungal infections, the mean age of patients was 37.2±21.5 years; male: 49 cases, female 66 cases. Infection of abdominal cavity accounted for 40.9%, infectious rate in respiratory tract and digestive tract were 26.9%, 21.8%, respectively. Candida albicans accounted for 67.6%. Use of broad-spectrum antibiotic and corticosteroids, neutropenia, severity of liver disease, improper medical manipulations as significant risk factors for fungal infection. Death rate of study group and control group was 59.1%, 34.8%, respectively(χ~2=36.0, P<0.001). In multivariate analysis, neutropenia, disseminated infection and severity of liver diseases were independent prognostic factors. Conclusions Identification of risk factors and predictors of a poor outcome in patients with severe hepatitis with fungal infections, it suggested that implications in prophylaxis of fungal infection, early diagnosis and appropriate therapy would be important for these patients.

关 键 词：重型肝炎 并发症 医院感染 真菌感染 危险因素 预后 

分 类 号：R512.6[医药卫生—内科学] R519[医药卫生—临床医学]