重型肝炎并发细菌及真菌感染的前瞻性研究

Complicated Bacteria and Fungi Infections in Patients with Severe Hepatitis: A Prospective Investigation

目的 研究近年重型肝炎患者并发细菌与真菌感染的临床特点及预后。方法 前瞻性观察我院 1999年11月～ 2 0 0 2年 11月收治的重型肝炎 ,将其中确诊为并发细菌和 (或 )真菌感染的病例作为研究对象 ,统计分析有关资料。结果 380例重型肝炎患者共发生 6 2例 (16 .3% )、73例次感染 ,其中医院感染 34例 (4 6 .6 % ) ;革兰阴性 (G- )杆菌和革兰阳性 (G+ )球菌感染分别占 4 9.3%和 2 7.4 % ;真菌感染占 2 3.3% ;>5 0 %的患者有程度不等的畏寒、发热、外周血白细胞总数及分类和中性粒细胞增高 ;380例重型肝炎患者病死率 4 8.2 % ,发生感染的病死率为 5 9.7% ,未发生感染的病死率为 4 5 .9% ,差异有显著性意义 (P <0 .0 5 )。结论 重型肝炎继发感染的临床表现与一般感染有所不同 ;医院感染发生率较高 ;G-杆菌是其常见病原菌 ;感染是导致死亡的重要因素 ,有效地控制感染是提高重型肝炎存活率的重要手段。

OBJECTIVE To investigate the clinical features and prognosis of complicated bacteria and fungi infections in patients with severe hepatitis in recent years. METHODS A prospective survey of patients with severe hepatitis was conducted in our hospital during Nov 1999 and Nov 2002. Those who are complicated with bacteria and fungi infections were closely studied, data were analyzed with statistics method. RESULTS Among 380 severe hepatitis patients 62 (16.3%) cases were complicated with infections, including 34 cases (46.6%) with nosocomial infections (49.3% with G - bacilli, 27.4% with G + cocci and 23.3% with fungi). More than half were with chill, fever, leukocytosis and neutrophilia. The fatality rate in all the 380 cases were 48.2%, from which 59.7% with complicated infections, 45.9% without them, the difference was significant (P<0.05). CONCLUSIONS Complicated infections in severe hepatitis patients differ from common infections in clinical features, which have a higher rate of nosocomial infection, and G - bacilli are the common pathogens. Complicated infections are the major factor leading to death. Thus to effectively control complicated infections is an important measure to improving survival rate.