重型病毒肝炎患者院内肺部感染的特点和防治

Nosocomial pulmonary infection in patients with hepatic failure

目的探讨重型肝炎患者院内肺部感染的临床特点和防治对策。方法用回顾性调查方法，调查１９９５年９月～１９９７年８月同一病房住院的重型肝炎患者院内肺部感染的发生率、病死率、深部痰细菌培养结果及肺部感染与其他部位感染、多器官功能衰竭的关系。结果两年内同一病房６８例重型肝炎患者中４０例（５８．８２％）发生院内肺部感染。２５例行深部痰细菌培养者２０例获阳性结果，其中１３例为多种细菌感染。菌种以条件致病菌为主，其中真菌、嗜麦芽假单胞菌、肠球菌、金葡菌较多见，耐药率高。不同时期发生肺部感染者痰菌的主要菌种有所不同。伴有肺部感染者亦常见其他部位感染，特别是原发性腹膜炎、胆道感染、肠道感染、败血症及合并真菌感染较多见，肝性脑病和肝肾综合征的发生率高，治疗效果差，病死率（８２．５％）明显高于无肺部感染的重型肝炎（５３．５７％）。结论重型肝炎患者常见院内肺部感染，病原菌以条件致病菌为主。肺部感染常与其他部位感染和并发症并存，病死率高。预防和治疗院内肺部感染需采取综合措施。

OBJECTIVE To study the prevalence and clinical features of nosocomial pulmonary infection in patients with hepatic failure (HF) were caused by severe viral hepatitis and the preventive measures for it. METHODS An epidemiological survey on the prevalence, fatality, sputum cultrue results and other aspects of nosocomial pulmonary infection were conducted in 68 patients with HF in same wards during 1995 to 1997. RESULTS Nosocomial pulmonary infection were observed in 40 of 68 (58.8%) patients with HF. Pathogenic bacteria or/and fungus were isolated from deep sputum specimens in 20 of 25 paticnts, and multiple infection (including fungul infection) were proved in 13 cases. The most common isolated pathogens are fungus, Pseudomonas maltophilia, Enterococcus and Staphylococus, with high resistance to multiple antibiotics. The isolated pathogens varies in different periods. Patients with nosocomial pulmonary infection are refered to poor outcome and high fatality, compared with patients free from pulmonary infection. CONCLUSION Nosocomial pulmonary infection is a common complicaton in patients with HF and opportunitive pathogens account for it's main cause. Comprehensive measures are necessary to the prevention against this fatal complication and effective antibiotics must be administrated as early as possible.