乙型肝炎后肝硬化患者医院感染临床分析与护理干预

Clinical analysis of nosocomial infections in cirrhosis patients after hepatitis B and the nursing interventions

目的探讨乙型肝炎后肝硬化患者医院感染的临床特征与相关因素以及护理干预措施,为医院感染防治提供依据。方法回顾性分析128例乙型肝炎后肝硬化患者的临床资料,依据发生医院感染与否分为感染组(33例)和非感染组(95例),对肝硬化医院感染的临床特点和危险因素进行病例对照研究。结果乙型肝炎后肝硬化患者医院感染发生率为25.78%,感染组中死亡率15.15%,非感染组死亡率3.16%,两组死亡率差异有统计学意义(P<0.05);感染多见于腹腔、呼吸道、胃肠道,分别占36.36%、24.24%、15.15%;革兰阴性杆菌是主要致病菌;两组对比感染组年龄、并发症、侵入性操作、Child-Pugh分级、住院时间、预防性应用抗菌药物等指标较非感染组差异有统计学意义(P<0.05)。结论乙型肝炎后肝硬化患者医院感染发生率较高,影响肝硬化预后,应引起临床重视,减少住院时间,改善肝功能,合理使用抗菌药物,避免不必要的侵入性诊疗操作,采取综合防治措施,以便降低肝硬化患者医院感染发生率。

OBJECTIVE To explore the clinical features and related factors for nosocomial infections in the patients with HBV-liver cirrhosis and propose the nursing interventions so as to provide basis for the prevention of nosocomial infections. METHODS A retrospective analysis of the clinical data of 128 patients with HBV-liver cirrhosis was performed, totally 33 patients with hospital infections were set as the infection group, 95 patients as the non-infection group. A case-control study was conducted to analyze the clinical characteristics and the related risk factors of nosocomial infections in the patients with cirrhosis. RESULTS The incidence of hospital infections in the patients with HBV-liver cirrhosis was 25.78%. The mortality of the infection group was 15.15%, 3.16% of the non-infection group, the difference was statistically significant （P〈0.05）. The abdominal cavity, respiratory tract, and gastrointestinal tract were the main infection sites, accounting for 36.36%, 24.24%, and 15.15%, respectively. The gram-negative bacilli were the main pathogenic bacteria. The difference in such indicators as the age, complications, invasive operation, Child-Pugh grading, hospitalization duration, and prophylactic use of antibiotics between the infection group and the non-infection group was statistically significant （P〈0. 05）. CONCLUSION The incidence of nosocomial infections in the patients with hepatic cirrhosis is high, which may influence the prognosis of the cirrhosis. The hospital should attach great importance, reduce the length of hospital stay, improve the liver function, use antibiotics reasonably, avoid the unnecessary invasive operation, and take comprehensive prevention measures so as to reduce the incidence of nosocomial infections in the cirrhosis patients.