复杂性腹腔感染并发肝功能障碍的病原菌分布特点及相关危险因素  

Distribution characteristics of pathogens and related risk factors in the patients with complicated intra-abdominal infection complicated with liver dysfunction

作　　者：何晨航 张北源[2] 陈鸣[2] 曹科[2] 王妍[2] 虞文魁 He Chen-hang;Zhang Bei-yuan;Chen Ming;Cao Ke;Wang Yan;Yu Wen-kui(Nanjing Drum Tower Clinical College of Xuzhou Medical University,Nanjing 210008,China;不详)

机构地区：[1]徐州医科大学鼓楼临床学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院重症医学科,江苏南京210008

出　　处：《中国急救医学》2023年第2期93-97,共5页Chinese Journal of Critical Care Medicine

基　　金：国家重大科研仪器项目(81927808);国家自然科学基金项目(82002082)。

摘　　要：目的探讨复杂性腹腔感染患者并发肝功能障碍(liver dysfunction,LD)的病原菌分布和相关危险因素。方法回顾分析2021年1月至2022年1月在南京大学医学院附属鼓楼医院重症医学科(ICU)收治的134例复杂性腹腔感染患者的临床资料,根据治疗过程中是否并发LD分为LD组和非LD组。比较两组患者的一般资料和腹水培养病原菌分布对LD发生的影响,并进行多因素Logistic回归分析以寻找并发LD的独立危险因素。结果LD组较非LD组患者腹水培养为革兰阴性(G^(-))菌的比例更高(64.0%vs.45.8%,P=0.035),且治疗过程中继发菌血症(56.0%vs.27.1%,P=0.001)、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)(69.3%vs.40.7%,P=0.001)、急性肾损伤(acute kidney injury,AKI)(57.3%vs.23.7%,P<0.001)和感染性休克(80.0%vs.49.2%,P<0.001)的比例更高。进一步行多因素Logistic回归分析发现,腹水培养为G^(-)菌(OR=2.642,95%CI 1.126~6.198,P=0.026)、并发AKI(OR=2.718,95%CI 1.052~7.026,P=0.039)和感染性休克(OR=2.663,95%CI 1.017~6.978,P=0.046)是影响复杂性腹腔感染患者并发LD的独立危险因素。结论复杂性腹腔感染并发LD患者腹水培养以G^(-)菌为主,腹水培养为G^(-)菌、并发AKI和感染性休克是复杂性腹腔感染并发LD的独立危险因素。Objective To investigate the distribution of pathogens and related risk factors of liver dysfunction(LD)in the patients with complicated intra-abdominal infection.Methods Retrospective analysis was made on the clinical data of 134 patients with complicated intra-abdominal infection admitted to the Department of Intensive Care Unit of Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2021 to January 2022.According to whether LD was complicated during the treatment,they were divided into LD group and non-LD group.The general data of the two groups and the influence of the distribution of pathogenic bacteria in ascites culture on the occurrence of LD were compared,and multivariate Logistic regression analysis was conducted to find the independent risk factors of LD.Results The proportion of gram negative(G^(-))bacteria in ascites culture was higher in the LD group(64.0%vs.45.8%,P=0.035),and the proportion of secondary bacteremia(56.0%vs.27.1%,P=0.001),acute respiratory distress syndrome(ARDS)(69.3%vs.40.7%,P=0.001),acute kidney injury(AKI)(57.3%vs.23.7%,P<0.001),and septic shock(80.0%vs.49.2%,P<0.001)was higher compared with the non-LD group.Further multivariate Logistic regression analysis showed that G^(-)bacteria in the ascites culture(OR=2.642,95%CI 1.126-6.198,P=0.026),AKI(OR=2.718,95%CI 1.052-7.026,P=0.039)and septic shock(OR=2.663,95%CI 1.017-6.978,P=0.046)were independent risk factors for LD in the patients with complicated intra-abdominal infection.Conclusions The ascites culture of patients with complicated abdominal infection complicated by LD is dominated by G^(-)bacteria.G^(-)bacteria in ascites culture,AKI and septic shock are independent risk factors of complicated intra-abdominal infection complicated with LD.

关 键 词：复杂性腹腔感染 肝功能障碍(LD) 急性呼吸窘迫综合征(ARDS) 急性肾损伤(AKI) 危险因素 

分 类 号：R572[医药卫生—消化系统] R575[医药卫生—内科学]