肝炎后肝硬化失代偿期患者合并医院感染临床分析

Clinical analysis of decompensated liver cirrhosis patients complicated with nosocomial infections after hepatitis

目的分析肝炎后肝硬化失代偿期患者合并医院感染的高危因素,探讨有效预防措施,降低医院感染的发生率。方法对2007年2月-2012年2月收治的360例肝炎后肝硬化失代偿期患者的医院感染进行调查,统计医院感染发生率,分析其发生的高危因素。结果 360例患者中发生医院感染率为33.9%,感染发生部位以呼吸道及腹膜为主,分别占41.8%、26.2%,侵入性操作(55.0%)、年龄>60岁(46.0%)、住院时间>30d的患者(57.5%)是发生医院感染的高危因素;导致医院感染的病原菌主要为革兰阴性菌,其次为革兰阳性菌及真菌。结论肝炎后肝硬化失代偿期患者机体免疫功能下降,实施侵入性操作、年龄>60岁以及住院时间>30d的患者较易发生医院感染,应减少侵入性操作,采取各种措施加强肝炎后肝硬化失代偿期患者的消毒隔离管理,以预防医院感染的发生。

OBJECTIVE To analyze the high risk factors of nosocomial infections in the decompensated liver cirrhosis patients after hepatitis and explore the effective prevention measures so as to reduce the incidence of nosocomial infections. METHODS A total of 360 patients with decompensated liver cirrhosis after hepatitis, who were treated in the hospital from Feb 2007 to Feb 2012, were investigated for the incidence of nosocomial infec- tions, then the incidence of nosocomial infections was taken for statistics, and the high risk factors were analyzed. RESULTS Of the 360 cases of patients, the incidence of nosocomial infections was 33.9% the respiratory tract and the peritoneal were the main infection sites, accounting for 41. 8% and 26. 2%, respectively. The invasive operation （55.0%）, more than 60 years of age （46. 0%）, and the hospitalization duration more than 30 days （57.5%） were the high risk factors of nosocomial infections. The gram-negative bacteria were the predominant pathogens causing the nosocomial infections, followed by the gram-positive bacteria and the fungi. CONCLUSION The immune function of the patients with decompensated liver cirrhosis declines after hepatitis, and the patients with invasive operation, more than 60 years of age, or hospitalization duration more than 30 days are prone to be infected. It is necessary to reduce the invasive operation and take measures to strengthen the disinfection and isola- tion of the patients with decompensated liver cirrhosis after hepatitis so as to prevent the nosocomial infections.