肝硬化患者感染性休克的病原学特征及危险因素分析

Etiological Characteristics and Risk Factors of Septic Shock in Patients with Liver Cirrhosis

目的:探讨肝硬化患者感染性休克的病原学特征,并分析其危险因素。方法:回顾性分析2012年1月-2015年4月期间本院收治的640例肝硬化患者的临床资料,分析肝硬化患者感染性休克发病率及感染部位分布,并分析感染性休克病原学特征,采用单因素和多因素logistic回归分析感染性休克的危险因素。结果:640例肝硬化患者感染性休克发病率为14.38%,感染部位分布于腹腔及消化道和肺部;共分离培养病原菌96株,包括革兰阴性杆菌52株(54.17%)、革兰阳性球菌18株(18.75%)、真菌26株(27.08%)。单因素分析结果显示,肝硬化患者并发感染性休克与年龄、抗生素、消化道出血、住院时间及肝性脑病有关(P<0.05),与性别、血清白蛋白、侵入性操作无关(P>0.05)。多因素logistic回归分析结果显示,年龄≥60岁、抗生素使用、消化道出血、肝性脑病及住院时间>30 d均为肝硬化患者感染性休克的危险因素(P<0.05)。结论:感染性休克患者病原菌以革兰阴性杆菌为主,年龄≥60岁、抗生素使用、消化道出血、肝性脑病及住院时间>30 d为肝硬化患者感染性休克的危险因素,应根据病原学特征及其危险因素采取相关措施,减少肝硬化患者感染性休克的发病风险。

Objective： To explore the etiological characteristics of septic shock in patients with liver cirrhosis,and to analyze the risk factors. Methods： The clinical data of 640 patients with liver cirrhosis, who were treated in Chongqing Three Gorges Central Hospital from January 2012 to April 2015, were retrospectively analyzed; the incidence and location of infectious shock, and the etiological characteristics in the patients with liver cirrhosis were also analyzed. The risk factors of septic shock was analyzed by single factor and multivariate logistic regression analysis. Results： The incidence of septic shock in 640 patients with liver cirrhosis was 14.38%, the site of infection was located in the abdominal cavity, digestive tract and lungs. A total of 96 strains of pathogenic bacteria were isolated and cultured, including 52 strains （54.17%） of gram negative bacilli, 18 strains （18.75%） of gram positive cocci, 26 strains （27.08%） of fungi. Single factor analysis showed that age, antibiotics, gastrointestinal bleeding, hospitalization time and hepatic encephalopathy were relevant to the septic shock in the patients with liver cirrhosis （P〈0.05）, the sexes, serum albumin, invasive procedure were not relevant （P〉 0.05）. Multivariate logistic regression analysis showed that age〉 60 years, the use of antibiotics, gastrointestinal bleeding, hepatic encephalopathy and hospitalization time 〉 30 d were influencing factors for the septic shock in patients with liver cirrhosis （P〈0.05）. Conclusion： Gram negative bacilli are the main pathogens in the patients with septic shock; the age≥ 60 years, the use of antibiotics, gastrointestinal bleeding, hepatic eneephalopathy and hospitalization time〉 30 d are influencing factors for the septic shock in the patients with liver cirrhosis. So relevant measures should be taken according to the etiological characteristics and risk factors in order to reduce the risk of septic shock in the patients with liver cirrhosis.