肝功能衰竭患者合并肺部感染的临床分析

Clinical analysis of pulmonary infection in patients with liver failure

目的了解肝功能衰竭合并肺部感染患者的临床特点,为预防和治疗提供依据。方法回顾性分析226例肝功能衰竭患者的临床资料,分析其肺部感染的发生率和病原菌分布,并根据有无肺部感染将病例分为感染组和对照组,比较两组间在性别、年龄、并发症及转归等方面的差异。结果 226例肝功能衰竭患者中有81例合并肺部感染,肺部感染发生率为35.84%(81/226),病原菌以真菌最多见(78.79%,26/33)。60岁以上肝功能衰竭患者肺部感染发生率为52.94%(18/34)显著高于60岁以下患者(32.81%,63/192)。感染组合并其他部位感染及肝性脑病、肝肾综合征的比例均显著高于对照组。疾病转归方面感染组的好转率(46.91%,38/81)低于对照组(61.38%,89/145),差异具有统计学意义(χ2=4.418,P=0.036),但两组患者病死率差异无统计学意义。结论肝功能衰竭患者合并肺部感染多见,尤其是年龄≥60岁的患者较易发生,病原菌以真菌为主。肺部感染常与其他部位感染及其他肝功能衰竭并发症并存,影响预后转归,需采取综合措施来预防和治疗。

Objective To investigate the clinical features and the preventive measures of pulmonary infection in patients with liver failure. Methods The clinical data of 226 patients with liver failure and the incidence of pulmonary infection and distribution of pathogen were analyzed, retrospectively. According to pulmonary infection, 226 patients were divided into two groups to compare the differences in sex, age, complications and prognosis, respectively. Results The incidence of pulmonary infection was 35.84%（81/226）, most were infected with fungi （78.79%, 26/33）. The incidence rate of pulmonary infection in patients with liver failure over 60 years （52.94%, 18/34） was significantly higher than in those under 60 years （32.81%, 63/192）. The rates of complicating with infections in other parts, hepatic encephalopathy and hepatorenal syndrome in infected group were significantly higher than control group. The improvement rate of infected group （46.91%, 38/81） was significantly lower than control group （61.38%, 89/145） （χ2 = 4.418, P= 0.036）. But there was no significantly difference in case fatality rate between the two groups. Conclusions Pulmonary infection was common in the patients with liver failure, especially those aged 60 years and over. Fungi were the predominant pathogens. Pulmonary infection frequently appeared with other infections and complications would affect the prognosis, so it should be prevented and controlled by comprehensive measures.