重型肝炎合并肺部感染患者相关危险因素的分析以及防治对策  

Risk factors analysis and preventive measures for patients with severe hepatitis and lung infection

作　　者：陈仁[1] 廖金瑶 陈文莉[1] 黄晶[1] 马晓军[1] 罗晓丹[1] 

机构地区：[1]广东省人民医院感染科,广东广州510080

出　　处：《中华疾病控制杂志》2016年第10期1029-1031,1035,共4页Chinese Journal of Disease Control & Prevention

基　　金：广东省科技计划项目(2006B36005018)

摘　　要：目的探讨重型肝炎合并肺部感染患者相关危险因素以及防治对策，为临床治疗提供参考依据。方法选取2014年1月～2016年1月在该院接受治疗的482例重型乙型肝炎患者，对确诊为发生肺部感染的患者采用单因素和多因素Logistic回归模型分析重型肝炎合并肺部感染患者相关危险因素，并且采用SPSS18．0软件对数据进行统计分析。结果482乙型肝炎肝硬化患者中有98例发生肺部感染，感染率为20．33％；临床特征主要为发烧、咳嗽、咯痰、肺部哕音和影像学改变及血中性粒细胞升高，病死率为21．43％。肺部感染患者中单种病原菌感染72例，混合感染26例。革兰阳性菌53株占47．32％，革兰阴性菌51株占45．54％，真菌8株占7．14％。多因素Logistic回归分析显示年龄、住院时间、严重程度、合并糖尿病、上消化道出血、侵人性操作、使用抗菌药物、血清白蛋白浓度均是合并肺部感染的独立危险因素。结论重型肝炎合并肺部感染患者相关危险因素比较多，故在治疗过程中，需要进行针对性的预防和治疗，以提高重型肝炎患者的存活率。Objective To investigate the predisposing factors and preventive measures of the patients with severe hepatitis and pulmonary infection, and to provide a reference basis for clinical treatment. Methods A total of 482 cases with severe hepatitis were selected from January 2014 to January 2016 in our hospital. Single factor and multiple factors Lo- gistic regression model analyses were used to analyze associated risk factors of pulmonary infection in patients with fulminant hepatitis, and SPSS 18.0 software was used for statistical analysis. Results Of the 482 patients with hepatitis B cirrhosis, 98 cases were with pulmonary infection, and the infection rate was 20. 33% ; Clinical features such as fever, cough, spu- tum, lung sounds and chest X-ray, CT changes and elevated blood neutrophils were the most common, the mortality rate was 21.43%. 72 pulmonary infection patients were with a single pathogen infection, while 26 cases were with a mixed infec- tion. 53 （47.32%） strains were of gram positive bacteria, 51 （45.54%） strains were of gram-negative bacteria, eight （7.14%） strains were of fungi. Multivariable Logistic regression analysis showed that age, length of hospital stay, severi- ty, diabetes mellitus, upper gastrointestinal bleeding, invasive operation, use of antimicrobial agents and the concentration of serum albumin were independent risk factors for pulmonary infection. Conclusions There are many factors associated with pulmonary infection in patients with fulminant hepatitis. Therefore, in the process of treatment, it is necessary for tar- geted prevention and treatment, in order to improve the survival rate of patients with severe hepatitis.

关 键 词：肝炎 肺 预后 危险因素 

分 类 号：R575.1[医药卫生—消化系统]