重型病毒性肝炎医院感染及危险因素研究

Risk Factors of Nosocomial Infection in Patients with Severe Viral Hepatitis

目的 探讨重型肝炎患者的医院感染及其危险因素。方法 前瞻性调查 1996年 4月～ 2 0 0 0年 12月住院的重型病毒性肝炎患者医院感染情况并进行统计分析。结果 重型肝炎医院感染率为 2 5 4 0 %、感染例次率31 85 % ,医院感染多数发生在入院前 2周、占 71 4 3% ,感染部位分布 :腹腔 2 8例次 ,下呼吸道 16例次 ,上呼吸道10例次 ,胆道 10例次 ,其他 15例次 ;单因素分析表明男性、预防性抗生素应用、侵袭性操作、AST、胆酶分离与医院感染有相关性 ;多因素分析表明男性、侵袭性操作是危险因素 ,预防性抗生素应用是保护性因素。结论 重型肝炎易发生医院感染 ,男性、侵袭性操作和预防性抗生素与医院感染发生有关。

OBJECTIVE To study the risk factors and clinical features of nosocomial infection in patients with severe viral hepatitis. METHODS A prospective study of nosocomial infection of severe viral hepatitis in our hospital from Apr 1996 to Dec 2000 was held and the data were analyzed. RESULTS The incidence of nosocomial infection in patients with severe viral hepatitis was 25.40%(63/248). Most of nosocomial infection occurred within two weeks of hospitalization(71.43%). Infection of abdominal cavity accounted for 35.44%, and the infection rate in lower respiratory tract, upper respiratory tract, gallbladder and bile ducts, and other region were 20.25%, 12.66%, 12.66% and 18.99%, respectively. Multiple regression analysis was selected, and the following variables significantly associated with nosocomial infection of severe viral hepatitis: male, prophylactic antibiotics therapy, invasive manipulations, serum aspartate aminotransferase level and the opposite levels between serum bilirubin and aminotransferase. The factors highly related with nosocomial infection analysis showed by Logistic analysis were: male, prophylactic antibiotics therapy and invasive manipulations. CONCLUSIONS The nosocomial infection is still a high frequent complication in patients with severe viral hepatitis and it should be paid attention to. The risk factors highly related with nosocomial infection caused by severe viral hepatitis are: male, prophylactic antibiotics therapy and invasive manipulations.