肝衰竭患者医院感染临床分析

Clinical analysis of nosocomial infections in patients with hepatic failure

目的探讨肝衰竭患者医院感染的发生率、好发部位、病原菌分布及对预后的影响,寻求有效的防治措施。方法采用回顾性研究方法分析226例肝衰竭患者医院感染的发生率、发生部位、病原菌分布及对住院时间、转归的影响,按是否感染将患者分为医院感染组和非医院感染组,对比分析两组间的差异。结果 226例肝衰竭患者中有45例发生医院感染,感染率19.91%;医院感染部位以消化系统和肺部最多见,分别占47.37%和45.61%;45例医院感染患者共检出49株病原菌,以真菌为主,共40株占81.63%,革兰阴性菌及革兰阳性菌分别占14.29%和4.08%;医院感染组患者住院时间>28d的占71.11%,明显高于非医院感染组的42.54%(P<0.01),但在疾病转归方面两组比较差异无统计学意义。结论肝衰竭患者医院感染主要发生于消化系统及肺部,病原菌以真菌为主,发生医院感染导致住院时间明显延长,增加了相应的医疗费用,需采取综合防治措施,降低医院感染率。

OBJECTIVE To explore the incidence of nosocomial infections, predilection sites, distribution of patho- gens, and influence on prognosis of the patients with hepatic failure so as to seek effective prevention and treat- ment measures. METHODS The clinical data of 226 patients with hepatic failure were analyzed retrospectively, in- cluding the infection rate, infection sites, distribution of pathogens, and the influence on length of hospital stay and prognosis, then the patients were divided into the infection group and the non-infection group according to the infection status, and the differences between the two groups were observed. RESULTS Of totally 226 hepatic fail- ure patients investigated, the nosocomial infections occurred in 45 cases with the infection rate of 19.91%, among which the patients with digestive system infections accounted for 47.37%, the patients with pulmonary infections 45.61 %. Among 49 strains of pathogens isolated from 45 patients with nosocomial infections, fungi accounted for 81.63%（40 isolates ）, gram-negative bacilli and gram-positive cocci accounted for 14.29% and 4.08%, respec- tively. The patients of the infection group with the hospitalization duration more than 28 days accounted for 71.11 %, significantly higher than 42.5% of the non-infection group（P〈0.01 ）, but the difference in the prog- nosis between the two groups was not statistically significant. CONCLUSION Among the patients with hepatic fail- ure, the nosoeomial infections mainly occur in the digestive system and the lungs; the fungi are dominant among the pathogens; the incidence of nosoeomial infections has resulted in the prolonged hospitalization duration and in- creased the medical cost, thus the comprehensive prevention and treatment measures should be taken so as to re- duce the incidence of nosocomial infections.