肝硬化上消化道出血并发感染的影响因素  

Influencing factors for infection in liver cirrhosis patients with upper gastrointestinal hemorrhage

作　　者：夏文恬 彭丽清[1] 李建红[1] 翁方中[1] 严骏[1] XIA Wen-tian;PENG Li-qing;LI Jian-hong;WENG Fang-zhong;YAN Jun(The First Hospital of Wuhan,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市第一医院重症医学科,湖北武汉430022

出　　处：《中华医院感染学杂志》2020年第22期3439-3442,共4页Chinese Journal of Nosocomiology

基　　金：湖北省医药卫生科研基金资助项目(WJ2015MB240)。

摘　　要：目的探究肝硬化上消化道出血患者并发感染影响因素及病原菌分布与耐药性。方法收集382例肝硬化患者临床资料,分析肝硬化患者上消化道出血发生率,依据肝硬化上消化道出血患者有无感染分为感染组、无感染组,分析肝硬化上消化道出血合并感染影响因素,分析肝硬化上消化道出血合并感染病原菌分布、耐药情况。结果肝硬化上消化道出血患者并发感染16例,占4.19%(16/382)。感染组出血程度为中重度、肝硬化分期为失代偿期占比较无感染组高,住院时间较无感染组长(P<0.05)。出血严重程度、失代偿期是肝硬化上消化道出血患者并发感染的危险因素(P<0.05)。16例并发感染患者,检出病原菌30株,革兰阴性菌19株(63.33%),革兰阳性菌9株(30.00%),真菌2株(6.67%)。结论失代偿期、出血严重程度、住院时间为肝硬化上消化道出血合并感染易感因素,依据感染病原菌分布和耐药性情况为患者选择有效抗菌药物。OBJECTIVE To explore the influencing factors for infection in the liver cirrhosis patients with upper gastrointestinal hemorrhage and observe the distribution and drug resistance of pathogens. METHODS The clinical data were collected from 382 patients with liver cirrhosis, the incidence of upper gastrointestinal hemorrhage was analyzed, the enrolled patients were divided into the infection group and the non-infection group according to the status of infection, the influencing factors for the infection in the liver cirrhosis patients with upper gastrointestinal hemorrhage were investigated, and the distribution and drug resistance of pathogens isolated from the patients with infection were observed. RESULTS Among the liver cirrhosis patients with upper gastrointestinal hemorrhage, 16 were complicated with infection, accounting for 4.19%(16/382). The proportions of the patient with moderate to severe hemorrhage and the patients with decompensated cirrhosis of the infection group were significantly higher than those of the non-infection group, the length of hospital stay of the infection group was significantly longer than that of the non-infection group(P<0.05). The severity of hemorrhage and decompensated period were the risk factors for the concurrent infection in the liver cirrhosis patients with upper gastrointestinal hemorrhage(P<0.05). Totally 30 strains of pathogens were isolated from 16 patients with concurrent infection, 19(63.33%) of which were gram-negative bacteria, 9(30.00%) were gram-positive bacteria, 2(6.67%) were fungi. CONCLUSION The decompensated period, severity of bleeding and length of hospital stay are the risk factors for the concurrent infection in the liver cirrhosis patients with upper gastrointestinal hemorrhage. It is necessary to choose effective antibiotics based on the distribution of pathogens and drug resistance.

关 键 词：肝硬化 上消化道出血 感染 病原菌 耐药性 

分 类 号：R657.31[医药卫生—外科学]