肝硬化患者感染性休克临床特征及预后

Clinical characteristics and prognosis of liver cirrhosis patients complicated with septic shock

目的探讨肝硬化患者合并感染性休克的临床特征及预后,为早期预防和控制肝硬化患者感染性休克及提高患者的生存率提供科学依据。方法回顾性分析2013年1-12月527例肝硬化患者并发感染性休克86例的临床资料,探讨肝硬化患者合并感染性休克的临床特征及预后,总结应对策略。结果 527例肝硬化患者发生感染性休克86例,发生率为16.32%;其中未发生感染性休克的441例患者死亡10例,病死率为2.27%,发生感染性休克的86例患者死亡9例,病死率为10.47%;86例肝硬化患者发生感染部位主要为肺部感染38例占44.19%、腹腔及肠道感染27例占31.39%;送检标本分离出病原菌75株,革兰阴性杆菌41株占54.67%、革兰阳性球菌14株占18.67%、真菌20株占26.66%,肝硬化患者发生感染性休克的危险因素为年龄、血清白蛋白、预防性应用抗菌药物、消化道出血、肝性脑病、住院时间。结论根据肝硬化患者合并感染性休克的临床特征,并针对危险因素给予应对策略,对降低肝硬化患者感染性休克有重要的意义,可改善患者预后。

OBJECTIVE To explore the clinical characteristics and prognosis of the liver cirrhosis patients complicat‐ed with septic shock so as to provide guidance for early prevention and control of septic shock in the liver cirrhosis patients and improve the survival rate .METHODS Totally 527 liver cirrhosis patients who were treated from Jan 2013 to Dec 2013 were enrolled in the study ,and the clinical data of 86 participants complicated with septic shock were retrospectively analyzed ;the clinical characteristics and prognosis of the liver cirrhosis patients complicated with septic shock were observed ,and the coping strategies were put forward .RESULTS The septic shock occurred in 86 of 527 liver cirrhosis patients ,with the incidence rate of 16 .32% ;totally 10 of 441 patients without septic shock died ,with the mortality rate of 2 .27% ;while 9 of 86 patients with septic shock died ,with the mortality rate of 10 .47% .Of 86 liver cirrhosis patients complicated with septic shock ,38 （44 .19% ） had pulmonary infec‐tions ,and 27 （31 .39% ） had abdominal and intestinal infections .A total of 75 strains of pathogens have been iso‐lated from the submitted specimens ,including 41 （54 .67% ） strains of gram‐negative bacilli ,14 （18 .67% ） strains of gram‐positive cocci ,and 20 （26 .66% ） strains of fungi .The risk factors for septic shock in the liver cirrhosis patients included the age ,serum albumin ,prophylactic use of antibiotics ,gastrointestinal hemorrhage ,hepatic en‐cephalopathy ,and length of hospital stay .CONCLUSION It is of great significance to take the coping strategies ai‐ming at the risk factors based on the clinical characteristics of the liver cirrhosis patients complicated with septic shock so as to reduce the incidence of septic shock and improve the prognosis .