肝硬化并发肺部感染临床研究

发布时间：2018-11-13 16:33

【摘要】：目的： 研究肝硬化并发肺部感染的影响因素、病原菌种类及临床特点和倍能的治疗效果,探讨肝硬化并发肺部感染的影响因素是否可以作为并发肺部感染独立的影响因素,研究肝硬化并发肺部感染与机体内细菌和真菌的相关性,最后探讨了伏立康唑和倍能联合治疗肝硬化并发肺部感染的效果,为临床早期诊断和治疗肝硬化并发肺部感染提供新的实验依据。 方法： 1)选择了518例肝硬化患者为研究对象,通过对以往病人的性别、年龄、住院时间、肝硬化child-pugh分级、合并基础疾病(糖尿病、慢性心肺疾病等情况)的并发症、随访等多因素进行回顾性总结分析； 2)选择了肝硬化患者462人为研究对象,分别观察了患者的咳嗽或咯痰症状,双侧或单侧肺部有湿Up音或叩诊浊音,X线显示肺部存有渗出性病灶,发热,体温超过38℃,外周血WBC10X109/L,以不同时间培养同种深部痰病原菌2次以上为阳性等临床症状进行了患者体内病原菌种类及临床特点的分析； 3)选择了53例肝硬化合并肺部感染患者为研究对象,对患者进行伏立康唑和倍能联合治疗和倍能单独治疗对比分析,以患者症状的缓解程度和肺炎性病灶的吸收消散情况为指标进行分析这两种药的治疗效果。 结果： 1)本文研究肝硬化患者518例,肺部感染并发的患者有144例,发病率为27.79%。①child-pugh分级为C级,该类患者肝功能受损严重,机体内免疫蛋白、白蛋白及体液因子减少,门静脉高压及侧支循环形成机体免疫力明显下降。②中老年患者(≥60岁)相比于年轻患者而言更易并发肺部感染。③病毒性肝炎引发的肝硬化比其他原因导致的肝硬化更有可能引发肺部感染。④呕血、误吸、PPI大量使用等因素使肝硬化并发上消化道出血患者的消化道细菌发生迁移,常常会引发或加重肺部感染。⑤患有糖尿病,心脑血管疾病以及慢性阻塞性肺病等肝硬化患者也会引发肺部感染。⑥住院时间越长,外源性细菌的感染几率增大,患者肺部的感染几率也逐渐增大。各因素之间相互独立。 2)有7例患者没有临床症状占10.4%,但胸部X线检测发现肺部出现感染。67例患者中,对48例患者进行了机体内深部痰的致病菌培养,其中36例为阳性,阳性率75.0%。共分离出病原菌78株,包括11种细菌64株,以革兰氏阴性菌为主,其中铜绿假单胞菌24株,占30.8%,为主要致病菌；6种真菌14株。其中8例患者存在两种或两种以上病原菌混合感染。 3)使用伏立康唑和倍能联合治疗患者的治愈率为33.3%,患者的显效率为63.0%,总有效率为96.3%；而单独使用倍能联合治疗患者的治愈率19.2%,患者的显效率为57.7%,总有效率为76.9%。伏立康唑和倍能联合治疗效果明显优于倍能单独治疗的治疗效果,差异有统计学意义(P0.05),患者治疗的前后肝功能不存在异常状况。 结论： 1) child-pugh分级、年龄、患有其他基础病、病情严重、并发症、住院时间等独立性多因素对患者的病情均有影响； 2)患者体内的病原菌种类较多,但出现易于出现混合菌治病感染的状况； 3)伏立康畔和倍能联合治疗的治疗效果优于倍能单独治疗。
[Abstract]:Purpose: To study the influence factors of liver cirrhosis complicated with pulmonary infection, the type of pathogenic bacteria, the clinical characteristics and the treatment effect of the times, and whether the factors influencing the infection of the liver cirrhosis complicated with the lung can be the independent influence of the concurrent pulmonary infection. Factors: To study the relationship between the pulmonary infection and the bacteria and fungi in the body of liver cirrhosis, and finally to discuss the effect of V-Likang on the treatment of liver cirrhosis complicated with pulmonary infection, and to provide a new experiment for the early diagnosis and treatment of cirrhosis complicated with pulmonary infection. On the basis of. Methods: 1) 518 patients with liver cirrhosis were selected as the study subjects, and the complications, follow-up and other factors such as the sex, the age, the time of hospitalization, the child-pugh classification, the combined basic diseases (diabetes, chronic heart and lung disease) and the follow-up were analyzed. A retrospective summary and analysis were performed; 2) 462 patients with liver cirrhosis were selected for study, and the cough or phlegm symptoms of the patient were observed. The two sides or one-sided lung had a wet up sound or a percussion voiced sound. The X-ray showed that the lung had an exudative focus, a fever, a body temperature of more than 38 鈩，

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