重型肝炎继发细菌感染的临床特点及疗效分析

发布时间：2018-11-08 11:43

【摘要】：目的探讨重型肝炎继发细菌感染的临床特点及预后。方法回顾性分析该院2012年6月至2015年10月收治的36例重型肝炎患者的临床资料,通过检测其炎症指标白细胞及中性粒细胞、C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、糖类抗原199(CA199)、铁蛋白的改变及早期继发感染的相关性,并及早进行抗感染治疗,对其相关资料及疗效进行统计分析。结果 36例患者均表现出1种或1种以上炎症指标水平升高,其中白细胞及中性粒细胞水平升高25例,占69.44%(25/36);CRP水平升高27例,占75%(27/36);ESR水平升高16例,占44.44%(16/36);PCT水平升高11例,占30.56%(11/36);CA199水平升高7例,占19.44%(7/36);铁蛋白水平升高23例,占63.89%(23/36)。所有患者均使用1种或1种以上抗生素进行抗感染,36例患者经抗感染及综合护肝治疗后,其中27例病情随着炎症指标的恢复正常或下降逐渐康复,但仍有9例死亡,死亡率为25.0%。9例死亡中因出现消化道大出血4例,2例出现肝性脑病,2例出现顽固性腹水及肝肾综合征3例。结论重型肝炎继发细菌感染发生率较高,以腹腔、呼吸道及胃肠道感染为主,病原菌主要为革兰阴性杆菌多见,通过炎症标志物的检测早期识别感染,并及早进行抗感染治疗,可有效防止因感染导致的病情恶化及相关并发症的出现,降低死亡率。
[Abstract]:Objective to investigate the clinical features and prognosis of bacterial infection secondary to severe hepatitis. Methods the clinical data of 36 patients with severe hepatitis from June 2012 to October 2015 were retrospectively analyzed. The erythrocyte sedimentation rate (ESR),) of C-reactive protein (CRP),) was determined by detecting the inflammatory markers of leukocytes, neutrophils and neutrophils. The changes of calcitonin proto (PCT), carbohydrate antigen 199 (CA199), ferritin and its correlation with early secondary infection were analyzed. Results the level of one or more inflammatory markers was increased in all the 36 patients, and the level of leukocyte and neutrophil was increased in 25 cases (69.44%) (27 / 36) (27 / 36), the level of 25 / 36); CRP was increased in 27 cases (27 / 36). The level of ESR was increased in 16 cases (44.44%) (11 / 36 / 16 / 36), CA199 in 7 cases (19.44%), CA199 in 11 cases (30.56%), CA199 in 7 cases (19.44%), CA199 in 7 cases (19.44%). Ferritin level increased in 23 cases, accounting for 63.89% (23 / 36). All patients were treated with one or more antibiotics for anti-infection. After anti-infection and comprehensive liver protection therapy, 27 patients recovered gradually, but 9 patients died. The mortality rate was 25.0.9 cases, including 4 cases of gastrointestinal hemorrhage, 2 cases of hepatic encephalopathy, 2 cases of refractory ascites and 3 cases of hepatorenal syndrome. Conclusion the incidence of secondary bacterial infection in patients with severe hepatitis is high, mainly in abdominal cavity, respiratory tract and gastrointestinal tract. The main pathogenic bacteria are Gram-negative bacilli. The infection is identified early by the detection of inflammatory markers, and anti-infection treatment is carried out early. It can effectively prevent the deterioration of the disease caused by infection and the occurrence of related complications, and reduce the mortality rate.
【作者单位】：柳江县人民医院;
【分类号】：R512.6

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