109例老年肝衰竭患者并发医院内感染的临床分析

Clinical analysis of nosocomial infection in 109 elderly patients with liver failure

目的:探讨老年肝衰竭患者并发医院内感染的发生率及预后的影响因素。方法:收集2000年至2009年我院收治的109例60岁以上的老年肝衰竭患者的住院临床资料,根据患者最终的结局分为死亡组和存活组。比较死亡组和存活组肝衰竭患者发生医院内感染的差异、感染的部位、患者年龄和住院时间与医院内感染发生率的关系,比较两组患者重要生化指标及并发症等。结果:老年肝衰竭患者医院内感染的发生率为85.3%(93/109);死亡肝衰竭患者医院内感染的发生率为89.7%(78/87),存活患者医院内感染的发生率为68.2%(15/22)(P<0.05);肝衰竭医院内感染最常见的为腹膜炎(43.7%),其次为呼吸道感染(25.4%)和胃肠道感染(19.2%);感染病原菌中细菌以大肠杆菌15株(23.08%)为主,真菌以白色念珠菌5株(7.69%)为主;住院时间小于2周、2～4周和大于4周患者医院内感染发生率分别为70.5%、83.6%和93.0%(P<0.05);肝肾综合征、肝性脑病、消化道出血、国际标准化比值(INR)>5、AST/ALT>1.2、TBil>513μmol/L、Alb<30g/L、CHO<1.6mmol/L、CHE<4000U/L、PLT<50×109/L、多重感染和电解质紊乱为肝衰竭预后不良的单影响因素;经Logistic多元回归分析,肝性脑病、INR>5、TBil>513μmol/L、多种感染为肝衰竭预后不良的独立预测因子。结论:老年肝衰竭死亡患者并发医院内感染发生率高。有4项多因素检验指标提示肝衰竭患者预后不良。

Objective：To investigate nosocomial infection incidence and influence risk factors of prognosis for elderly patients with liver failure.Methods：The 109 elderly patients with liver failure（age〉60） from 2000 to 2009 were retrospectively studied.International consensus criteria were applied to assess the causality of prognosis,in which the acute insults and risk factors were analyzed.Results：The infection incidence in elderly liver failure patients was 85.3%;The infection incidence in liver failure death was 89.7%,in survival group was 68.2%;The most common infection was peritonitis（43.7%） and the secondary was respiratory tract infection（25.4%）;The common pathogens were escherichia coli（23.08%）;Among test indexes the single factor influencing the prognosis of elderly patients with liver failure was as follows hepatorenal syndrome,HE,gastrointestinal hemorrhage,INR〉5,AST/ALT〉1.2,TBil〉513μmol/L,Alb〈30g/L,CHO〈1.6mmol/L,CHE〈4000U/L,PLT50×10^9/L,multiple infection,electrolyte imbalance.Through Logistic regression,4 indexes as HE,INR5,TBil513μmol/L,multiple infection were independent predictable factors of poor prognosis of elderly patients with liver failure.Conclusion：The rate of nosocomial infection in elderly liver failure patients is high and the mortality is very high too.There are 4 multi-factors of test indexes show that prognosis of elderly patients with liver failure is bad.