乙型肝炎肝硬化患者院内获得性感染相关危险因素分析

Risk factors of nosocom ial infections in patients with hepatitis B liver cirrhosis

目的分析影响乙型肝炎肝硬化患者发生院内获得性感染相关的危险因素,以为临床诊治提供可借鉴的经验。方法 2015年1月～2017年1月在我院诊治的乙型肝炎肝硬化患者280例,查阅出院病历,结合临床症状、体征、血白细胞或/和中性粒细胞比率增高、血降钙素原水平升高、细菌培养阳性和影像学检查结果并参照卫生部2001年颁布的《医院感染诊断标准》诊断感染,对影响患者院内感染的因素先行单因素分析,再对有显著意义的因素采用多元Logistic回归分析。结果在280例乙型肝炎肝硬化患者中,发生院内感染57例(20.4%),其中自发性细菌性腹膜炎18例(31.6%),呼吸道感染12例(21.1%),胃肠道感染10例(17.5%),泌尿系感染7例(12.3%)和败血症10例(17.5%);经单因素分析显示,年龄(x^2=7.416,P=0.006)、住院时间(t=28.247,P<0.001)、血清白蛋白(t=2.661,P=0.008)、CD4^+T淋巴细胞ATP值(t=8.122,P<0.001)、Child-Pugh分级(x^2=10.577,P=0.005)、侵入性操作(x^2=29.214,P<0.001)、腹水(x^2=25.776,P<0.001)、消化道出血(x^2=111.434,P<0.001)为影响乙型肝炎肝硬化患者发生院内获得性感染的相关危险因素,而感染与患者性别和是否发生肝性脑病无显著性相关(P>0.05);经多因素Logistic回归分析,结果显示,年龄、侵入性操作、腹水、消化道出血、住院时间和血清白蛋白水平是发生院内获得性感染的独立危险因素。结论乙型肝炎肝硬化患者易发生院内感染,尤其是年龄较大、肝储备功能差、出现并发症和住院时间较长者。临床医生应该对这类患者给予特殊的关怀,严格无菌操作,预防并发症发生,促进肝功能恢复。

Objective To analyze the risk factors of nosocomial infections in patients with hepatitis B liver cirrhosis. Methods 280 patients with hepatitis B liver cirrhosis were recruited in our hospital between January2015 and January 2017,and the diagnosis of infections was carried out according to the clinical,blood,bacteria culture and imaging results. The independent risk factors of acquired infection were analyzed by Logistic regression analysis. Results Out of the 280 patients with liver cirrhosis, the nosocomial infections occurred in57(20.4%),including spontaneous bacteria peritonitis in 18(31.6%),respiratory infection in 12(21.1%),gut infection in 10(17.5%),urological infection in 7(12.3%)and septicemia in 10(17.5%);univariate analysis showed that age(x^2=7.416,P=0.006),hospital stay(t=28.247,P<0.001),serum albumin(t=2.661,P=0.008),ATP of peripheral blood CD4^+T lymphocyte(t=8.122,P<0.001),Child-Pugh score(x^2=10.577,P=0.005),invasive manipulation(x^2=29.214,P<0.001),ascites(x^2=25.776,P<0.001) and gastrointestinal bleeding(x^2=111.434,P<0.001) were,while the gender and hepatic encephalopathy were not(P>0.05),the risk factors for acquired infections;multivariate Logistic analysis demonstrated that age,invasive manipulation,ascites,gastrointestinal bleeding,hospital stay and serum albumin level were the independent risk factors for the nosocomial infections in these patients. Conclusion Patients with liver cirrhosis are susceptible to nosocomial infections,especially in those with elderly age,lower serum albumin level and long hospital stay,and the clinicians should pay attention to them and eliminate the risk factors of nosocomial acquired infection.