肝硬化门静脉高压症患者断流术后医院感染危险因素及预防对策  

Risk factor of nosocomial infections in patients with liver cirrhosis and portal hypertension after consequence of devascularization and the control strategies

作　　者：张雪峰 

机构地区：[1]杭州第六人民医院外科,浙江杭州310023

出　　处：《中华医院感染学杂志》2013年第12期2886-2888,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅科研基金(2011KYA069)

摘　　要：目的探讨肝硬化门静脉高压症患者断流术后转归的影响因素,为预防术后感染和制定正确的防治方案提供科学依据。方法分析行断流术的肝硬化门静脉高压症患者247例,将术后发生感染患者分为观察组和对照组,对各临床指标进行对比分析,并行非条件logistic多因素回归分析。结果 247例患者中共有32例发生感染,感染率为12.96%,以肺部感染为主,占40.63%;单因素卡方检验分析,医院感染与肝功能Child-Pugh分级、腹水史、术中出血量、手术时间、抗菌药物使用种类、总胆红素、血氨、白蛋白、A/G比值有关(P<0.05),logistic多因素回归分析发现,肝功能分级(OR=1.638,P=0.008)、抗菌药物使用种类(OR=1.898,P=0.017)、A/G比值(OR=2.718,P=0.002)和术中出血量(OR=2.985,P=0.003)是医院感染发生的独立危险因素。结论断流术后患者医院感染发生与多种因素有关,针对医院感染的易患因素实施有效措施,包括改善患者机体状况、改善肝功、规范手术操作、合理使用抗菌药物等,以减少和控制医院感染的发生。OBJECTIVE To investigate the impact factors of outcome of the patients with liver cirrhosis and portal hypertension after devaseularization so as to provide a scientific basis for the prevention of postoperative infections and the development of prevention programs. METHODS The clinical data of 247 patients with liver cirrhosis and portal hypertension who received devascularization operation were analyzed. The patients were divided into the observation group and the control group according to the infection after the operation. The independent variables and the clinical indicators were analyzed, then the multivariate logistic regression analysis was performed. RESULTS Of totally 247 cases of patients, the infections occurred in 32 cases with the infection rate of 12.96%, the pulmonary infections were dominant, accounting for 40.630%. The univariate chi-square test indicated that the incidence of the nosocomial infections was related to the liver function Child-Pugh grading, history of ascites, the intraoperative blood loss, operation duration, types of antibiotics used, the total bilirubin, blood ammonia, albumin, or albumin/globulin value （P〈0.05） ; while the multivariate logistic regression analysis concluded that the liver function grading （OR=1. 638,P=0. 008）, types of antibiotics used （OR=1.898,P=0. 017）, albumin/ globulin value（OR= 2. 718 ,P=0. 002）, and the volume of intraoperative blood loss（OR= 2. 985, P= 0. 003）were the independent risk factors of the nosocomial infections. CONCLUSION The incidence of nosocomial infections after the devascularization operation is influenced by many factors, therefore, the effective measures including improving the nutritional status, improving the liver function, standardizing operation procedures, reasonably using antibiotics should be carried out according to the risk factors so as to reduce to the incidence of nosocomial infections.

关 键 词：肝硬化 门静脉高压症 危险因素 预防措施 

分 类 号：R181.32[医药卫生—流行病学]