失代偿期肝硬化合并腹腔感染患者的临床特征及预后影响因素分析  

Clinical characteristics and prognostic factors of decompensated liver cirrhosiscomplicated with intra-abdominal infection

作　　者：徐尧[1] 冯静云[1] 郑立明[1] 陈菲菲[1] XU Yao;FENG Jingyun;ZHENG Liming;CHEN Feifei(Department of Critical Care Medicine,the Third People's Hospital of Changzhou,Changzhou Jiangsu 213001,China)

机构地区：[1]常州市第三人民医院重症医学科,江苏常州213001

出　　处：《中国感染与化疗杂志》2023年第3期313-317,共5页Chinese Journal of Infection and Chemotherapy

基　　金：常州市卫生健康委员会重大科技项目(ZD202119)。

摘　　要：目的探讨失代偿期肝硬化合并腹腔感染患者的临床特征及预后影响因素。方法回顾性分析2016年6月—2020年12月于常州市第三人民医院收治的失代偿期肝硬化合并腹腔感染患者的临床资料,根据随访记录按照患者预后好转程度分为预后良好组和预后不良组,比较两组患者的基线资料和临床指标的差异,并利用多因素logistic回归分析影响失代偿期肝硬化合并腹腔感染患者预后的危险因素。结果139例失代偿期肝硬化合并腹腔感染患者的典型临床表现为发热(79.9%)、腹痛(76.3%)和腹胀(70.5%)。75例感染患者的腹水培养阳性病原菌86株,依次分别为大肠埃希菌、溶血链球菌、肺炎克雷伯菌、铜绿假单胞菌和屎肠球菌。预后不良组患者的年龄、白蛋白(ALB)、血Na^(+)、总胆红素(TBIL)水平、ChildPugh分级、合并高血压、合并肝性脑病、并发上消化道出血和肝肾综合征相比预后良好组显著更高。多因素分析结果显示,年龄、ALB、血Na^(+)、Child-Pugh分级、合并高血压、合并肝性脑病、并发上消化道出血和肝肾综合征是影响失代偿期肝硬化合并腹腔感染患者预后的独立危险因素(P<0.05)。结论失代偿期肝硬化合并腹腔感染患者以发热、腹痛和腹胀等经典临床表现为主,感染预后较差,影响预后的危险因素众多,临床应采取针对性干预措施改善预后,提高患者生存率。Objective To investigate the clinical characteristics and prognostic factors in patients with decompensated liver cirrhosis complicated with intra-abdominal infection.Methods The clinical data of 139 patients with decompensated liver cirrhosis complicated with intra-abdominal infection treated in Changzhou Third People's Hospital from June 2016 to December 2020 were analyzed retrospectively.The patients were assigned to good outcome group or poor outcome group according to the outcomes at follow-up visits.The baseline data and clinical variables were compared between the two groups.Multivariate logistic regression model was used to analyze the factors affecting the outcome of patients with decompensated liver cirrhosis complicated with intraabdominal infection.Results The typical clinical manifestations of decompensated liver cirrhosis complicated with intra-abdominal infection were fever(79.9%),abdominal pain(76.3%)and abdominal distension(70.5%).A total of 86 strains of pathogens were isolated from ascites of 75 patients,including Escherichia coli,Streptococcus haemolyticus,Klebsiella pneumoniae,Pseudomonas aeruginosa and Enterococcus faecium.Old age,albumin,serum Na^(+),total bilirubin,Child-Pugh classification,hypertension,hepatic encephalopathy,upper gastrointestinal bleeding and hepatorenal syndrome were significantly associated with poor prognosis.Multivariate analysis showed that age,albumin,serum Na^(+),Child-Pugh classification,hypertension,hepatic encephalopathy,upper gastrointestinal bleeding and hepatorenal syndrome were independent risk factors for poor outcome of patients with decompensated cirrhosis complicated with intra-abdominal infection(P<0.05).Conclusions The typical clinical manifestations of decompensated liver cirrhosis complicated with intra-abdominal infection are mainly fever,abdominal pain and abdominal distension.The prognosis of intra-abdominal infection is poor and there are many risk factors resulting in poor outcome of patients.Clinical intervention measures should be taken to ad

关 键 词：失代偿期肝硬化 腹腔感染 预后 

分 类 号：R515[医药卫生—内科学]