肝硬化合并上消化道出血患者医院感染的影响因素分析及抗菌药物应用的预防效果  

Analysis of risk factors of nosocomial infections in cirrhotic patients with upper gastrointestinal hemorrhage and the preventive effect of antibacterials

作　　者：姜小龙 陈新华 周花梅 姜海 张云路 JIANG Xiao-long;CHEN Xin-hua;ZHOU Hua-mei;JIANG Hai;ZHANG Yun-lu(Jiangshan Beilin Hospital,Quzhou,Zhejiang 324100,China)

机构地区：[1]江山贝林医院消化内科,浙江衢州324100

出　　处：《中华医院感染学杂志》2018年第16期2427-2429,2434,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81071515)

摘　　要：目的探讨肝硬化合并上消化道出血患者医院感染的影响因素分析及抗菌药物应用的预防效果。方法回顾性分析2015年5月-2017年10月于医院住院的93例肝硬化合并上消化道出血患者的临床资料,采取随机数字表法将患者分为试验组48例与对照组45例,试验组患者应用预防性抗菌药物治疗,对照组患者不给予预防性抗菌药物治疗。观察患者抗菌药物应用的预防效果,收集患者的年龄、性别、肝脏储备功能进行量化评估表(Child-Pugh)积分、预防性应用抗菌药物、三腔二囊管压迫止血的资料,单因素及多因素分析患者医院感染的相关影响因素。结果 93例患者中医院感染17例,感染率为18.28%;试验组患者感染4例、再出血3例、病死1例,对照组患者感染13例、再出血12例、病死2例,两组患者医院感染、再出血情况比较差异有统计学意义(P<0.05),住院病死情况比较差异无统计学意义(P=0.664);多因素Logistic回归分析结果显示,年龄≥55岁、ChildPugh积分≥11分以及未预防性应用抗菌药物是发生医院感染的影响因素(P<0.05)。结论肝硬化合并上消化道出血患者的医院感染相关影响因素为年龄、Child-Pug积分、预防性抗菌药物治疗,通过预防性应用抗菌药物,有效降低了再出血率、医院感染发生率,改善患者预后。OBJECTIVE To investigate the risk factors of nosocomial infections in cirrhotic patients with upper gastrointestinal bleeding and the preventive effects of antibacterials.METHODS The clinical data for 93 patients with cirrhosis complicated with upper gastrointestinal bleeding who were admitted from May 2014 to May 2017 were analyzed retrospectively.The patients were randomly divided into test group（48 cases）and control group（45 cases）.The test group was treated with prophylactic antibiotics and the control group was not given prophylactic antibiotics.The preventive effect of the application of antibacterials was observed.The patients age,gender,quantitative evaluation table（Child-pugh）score of liver reserve ability,prophylactic use of antibiotics,SengstakenBlakemore tube compression hemostasis data were collected.The influencing factors of nosocomial infection were analyzed with univariate and multivariate analyses.RESULTS Among the 93 cases of patients,nosocomial infection occurred in 17 cases,and the infection rate was 18.28%.In the test group,there were 4 cases of nosocomial infection,3 cases of recurrent hemorrhage,and 1 case of death.In the control group,there were 13 cases of nosocomial infection,12 cases of recurrent hemorrhage,and 2 cases of death.There were significant differences in nosocomial infection and recurrent hemorrhage between the two groups（P〈0.05）,and there was no significant difference in inpatient mortality（P=0.664）.Multivariate Logistic regression analysis using SPSS 17.0 software found that age≥55 years old,Child-Pugh score≥11 and no prophylactic use of antimicrobial agents were significantly conditions affecting nosocomial infections（P〈0.05）.CONCLUSION The survey results showed that the influencing factors of nosocomial infections in cirrhotic patients with upper gastrointestinal hemorrhage were age,ChildPug score,and prophylactic use of antimicrobial agents.Through the preventive application of antibiotics,the rate of recurrent hemorrhage and the incidenc

关 键 词：肝硬化 上消化道出血 医院感染 影响因素 抗菌药物 

分 类 号：R181.3[医药卫生—流行病学]