肝衰竭合并细菌和真菌感染的特点及对预后的影响

Bacterial and Fungal Infection in Liver Failure Patients: the Clinical Characteristics and the Role in Prognosis

目的:研究肝衰竭合并细菌和真菌感染的临床特点及其对预后的影响。方法:查阅我科2006年5月至2012年5月245例住院肝衰竭患者的临床资料,对其感染率、感染部位、病原菌分布、感染发生的影响因素及感染对预后影响进行分析。结果:肝衰竭患者感染率为66.5%,感染部位主要为腹腔、肺部、胆道和肠道,分别占46.0%、35.6%、17.8%和12.9%;病原菌以革兰氏阴性杆菌为主(83.3%);导致感染发生的影响因素为高龄、肝衰竭类型和分期、侵入性操作、糖尿病及其他并发症;245例肝衰竭患者病死率为53.9%,感染组病死率(68.7%)明显高于非感染组(24.4%),多部位感染增加肝衰竭患者病死率。结论:感染是肝衰竭患者最常见的并发症之一,病原菌以革兰氏阴性杆菌为主,针对感染特点及时防治,可提高患者生存率。

Objective To investigate the clinical characteristics and the role in prognosis of bacterial and fungal infection in patients with liver failure.Methods The clinical data of 245 patients with liver failure treated in our department from May 2006 to May 2012 were investigated and the infection rate,the infection sites,pathogens,the influential factors of infection and its effect on the prognosis were analyzed.Results The infection incidence in liver failure patients was 66.5%.Abdominal cavity,lung,biliary tract and intestine were the most common infection sites with infection rates of 46.0%,35.6%,17.8% and 12.9%,respectively.The most frequently detected pathogens were Gram-negative bacteria(83.3%).Advanced age,liver failure type and stage,invasive operation,diabetes and other complications were associated with high incidence of bacterial and fungal infection.The mortality of 245 patients with liver failure was 53.9%,the mortality rate of infective group(68.7%) was significantly higher than that of non-infective group(24.4%).Multiple Infection sites could increase mortality in patients with liver failure.Conclusion Infection is one of common complications in liver failure patients,Gramnegative bacteria is the main microorganisms.According to clinical characteristics of liver failure patients with infection,treatment in time can increase the survival rate of the patients.