重型肝炎合并肺部感染的临床分析

Pulmonary infection in patients with hepatic failure

目的 探讨重型肝炎患者并发肺部感染的临床特点及病原菌对抗菌剂的敏感性。方法 回顾性分析某院近 4年来重型肝炎患者合并肺部感染的资料。结果 1 0 9例重型肝炎患者中并发肺部感染 38例 (34.86 % ) ,临床表现以发热 (81 .5 8% )、肺部音 (76 .32 % )、胸片改变 (73.6 8% )为主 ,6 0 .5 3%的患者外周血白细胞增高 ,73.6 8%的患者胸片异常。肺部感染多发生于入院后 2～ 4周。对 2 8例肺部感染者进行痰培养 ,发现 1 9例阳性 ,其中 9例为多种细菌感染 ;菌种以条件致病菌为主 ,其中真菌、铜绿假单胞菌、金黄色葡萄球菌较多见 ,耐药率高。肺部感染者亦常合并其他部位感染 ;有创伤性操作者感染比例较高 ,同时肝性脑病和肝肾综合征的发生率高。治疗效果差 ,病死率达 81 .5 0 % ,明显高于无肺部感染的重型肝炎者 (5 2 .38% )。结论 重型肝炎患者易合并肺部感染 ,其临床表现不典型 ,病原菌以条件致病菌为主。肺部感染常合并其他部位感染。防治肺部感染需采取综合措施 。

Objective To study the clinical characteristics of pulmonary infection in patients with hepatic failure (HF) and bacterial sensitivity to antimicrobial agents. Methods A retrospective analysis on the pulmonary infection was conducted in patients with HF in recent 4 years. Results Pulmonary infection was observed in 38 of 109 patients with HF, the main clinical features were fever ( 81.58% ), pulmonary rales ( 76.32% ), leukocytosis of peripheral blood ( 60.53% ) and abnormality of chest x ray ( 73.68% ), pulmonary infection often occurred after 2-4 weeks of admission, bacteria and fungus were isolated from sputum specimens in 19 of 28 patients. The most common isolated pathogens were fungus, Pseudomonas aeruginosa and Staphylococcus aureus, and had high resistance to multiple antimicrobial agents. Patients with pulmonary infection were often associated with infection in other sites and had high mortality. Conclusion Pulmonary infection is a common complication in patients with HF and opportunistic pathogens account for its main cause. Comprehensive measures are necessary to the prevention of this fatal complication, and effective antimicrobial agents must be administered as early as possible.