肝硬化患者合并感染的回顾性研究

目的:探讨近年来复旦大学附属中山医院肝硬化患者感染状况、危险因素及预后。方法:对2002年1月-12月复旦大学附属中山医院收治的291例肝硬化患者进行回顾性调查分析。结果:291例肝硬化患者的感染率为21.65%(63/291例)。其中,院外感染率12.37%(36/291例),院内感染率8.59%(25/291例),院内外混合感染率0.69%(2/291例);感染部位分布;腹腔(自发性细菌性腹膜炎)33.80%(24/71例次),呼吸道28.17%(20/71例次),泌尿系16.90%(12/71例次),肠道5.63%(4/71例次),败血症5.63%(4/71例次),胆系4.24%(3/71例次),其他(皮肤、引流液等)5.63%(4/71例次);感染菌种分布;革兰阳性球菌36.84%(14/38株),革兰阴性杆菌31.58%(12/38株),真菌31.58%(12/38株)。291例肝硬化患者总病死率为7.90%(23/291例),感染组病死率22.22%(14/63例),明显高于非感染组病死率4.50%(9/228)。结论:肝硬化患者病情危重,易并发各种感染,其中老年患者、肝功能损害明显、严重并发症、合并多种器质性疾病、侵袭性医疗操作和广谱抗菌药的应用均可成为感染的诱发因素,增加病死率;且深部真菌医院内感染呈明显上升趋势,给肝硬化患者合并感染的防治增加了难度。

A Retrospective Study of Bacterial Infection in Patients with Liver Cirrhosis

Objective: To study the risk factors and prognosis of bacterial infection in the patients with liver cirrhosis admitted in to our hospital. Methods: 291 cases of liver cirrhosis during Jaa 2002 to Dec. 2002 were investigated and analyzed retrospectively. Results: Of 291 cases with liver cirrhosis, 63 cases were complicated by infection with the rate of 21. 65%(63/291). Social infection rate, nosocial infection rate and coinfection rate were 12. 37% (36/291), 8. 59% (25/291) and 0. 69% (2/291), respectively. Infection of abdominal cavity (Spontaneous bacterial peritonitis) accounted for 33. 80% (24/71), and infection rate in respiratory tract, urinary tract, intestinal tract, blood, gallbladder and bile ducts, and other region were 28. 17% (20/71), 16. 90% (12/71), 5. 63% (4/71), 5. 63% (4/71), 4. 24% (3/71), 5. 63%(4/71), respectively. Gram-positive Cocci infection rate was 36. 84%(14/38), Gram-negative Bacilli and fungi were both 31. 58% (12/38). The morbidity of 291 patients was 7. 90%(23/291). The morbidity of the infected cases was 22. 22%(14/63), extremely higher than no-infected cases(4. 50%). Conclusion:The factors related to infection were age of patients, liver function, severe underlying diseases, improper medical manipulations and use of broad-spectrum antibiotics. It makes prevention and treatment of infections in patients with liver cirrhosis difficult.