人工肝支持治疗肝衰竭患者感染相关危险因素分析

发布时间：2018-04-07 15:15

本文选题：肝衰竭　切入点：人工肝支持治疗　出处：《蚌埠医学院》2017年硕士论文

【摘要】：目的:分析人工肝支持治疗肝衰竭患者发生感染的相关危险因素,为临床医师采取有效措施,降低感染率,提高肝衰竭患者生存率提供依据。方法:收集2012年1月至2016年11月蚌埠医学院第一附属医院感染科住院诊断为肝衰竭患者的临床资料,如性别、年龄、肝功能、凝血功能、导管留置时间、是否应用抗生素、是否合并并发症、肝衰竭类型、Child-Pugh评分、MELD评分、外周血白细胞、中性粒细胞计数、血小板计数等。将患者分为人工肝组和非人工肝组,非人工肝组采用内科综合治疗,人工肝组采用内科综合治疗联合人工肝支持治疗。回顾性分析两组疗效和感染差异;进一步将人工肝组分为感染组和非感染组,采用回归分析方法寻找人工肝治疗肝衰竭患者继发感染的相关危险因素。结果:ALSS组ALT、AST、TBIL较基线水平显著下降,CHE、ALB、PTA较基线水平显著上升;非ALSS组ALT、AST、TBIL较基线水平下降,ALB、PTA较基线水平明显上升,差异具有统计学意义。CHE治疗前后的差异无统计学意义。ALSS组ALT、AST、CHE、TBIL、PT、PTA治疗前后下降或上升幅度优于非ALSS组,差异有统计学意义(P0.05)。ALSS组和非ALSS组好转率分别为53.04%和44.29%,差异无统计学意义(P0.05)。36.08%(92/255)的肝衰竭患者出现感染,ALSS组和非ALSS组感染率分别为40.87%(47/115)和32.14%(45/140),两组间差异无统计学意义(χ2=2.085,P0.05)。常见感染部位为下呼吸道(40.17%)、腹腔(27.45%)、上呼吸道(11.76%)、肠道(7.84%)、血流(5.88%)。感染患者中17.39%表现为两部位感染。单因素logistic分析Child-Pugh分级、MELD评分、PTA、预防性应用抗菌素、导管留置时间以及合并并发症是ALSS组肝衰竭患者发生感染的危险因素(OR值分别为1.051、1.019、0.968、0.128、1.114、5.170),多因素logistic回归分析表明合并并发症和导管留置时间是ALSS组感染患者主要危险因素(OR值分别为11.590和1.253)。结论:内科综合治疗能够有效改善肝衰竭患者的肝功能及凝血功能,联合人工肝支持治疗疗效更好;人工肝治疗肝衰竭患者感染率高于未行人工肝治疗者,继发感染是肝衰竭患者预后不佳的重要原因;合并并发症和导管留置时间是人工肝治疗肝衰竭患者感染的独立危险因素。
[Abstract]:Objective: to analyze the risk factors of infection in patients with liver failure treated with artificial liver support, so as to provide evidence for clinicians to take effective measures to reduce the infection rate and improve the survival rate of patients with liver failure.Methods: from January 2012 to November 2016, clinical data of patients with liver failure, such as sex, age, liver function, coagulation function, catheter indwelling time, and whether antibiotics were used, were collected in the infection Department of the first affiliated Hospital of Bengbu Medical College.There were complications, Child-Pugh score and meld score, peripheral blood leukocyte count, neutrophil count, platelet count and so on.The patients were divided into artificial liver group and non-artificial liver group.Retrospective analysis of the two groups of efficacy and infection differences, further divided the artificial liver group into infection group and non-infection group, using regression analysis method to find the artificial liver treatment of liver failure patients secondary infection risk factors.Results compared with the baseline level, the level of TBIL in the ALSS group was significantly lower than that in the baseline level, and that in the non-ALSS group was significantly higher than that in the baseline level, and that in the non-ALSS group was significantly higher than that in the baseline level, and that in the non-ALSS group was significantly higher than that in the baseline level, and that in the non-ALSS group was significantly higher than that in the baseline level.There was no significant difference between before and after treatment. Before and after treatment, the decrease or rise of alt in ALSS group was higher than that in non-#en0# group.The common sites of infection were 40.17 in lower respiratory tract, 27.45 in abdominal cavity, 11.76 in upper respiratory tract, 7.84 in intestinal tract and 5.88 in blood flow.17.39% of the infected patients showed two sites of infection.Single factor logistic analysis of Child-Pugh grading meld score, prophylactic use of antibiotics,The risk factors of hepatic failure in ALSS group were catheter indwelling time and complications. OR value was 1.051v 1.0190.960.1281.1145.170, respectively. Multivariate logistic regression analysis showed that complications and catheter indwelling time were the main risk factors of infection in ALSS group.The OR values were 11.590 and 1.253%, respectively.Conclusion: comprehensive medical treatment can effectively improve the liver function and coagulation function of patients with liver failure, and the effect of combined artificial liver support therapy is better, the infection rate of patients with artificial liver failure is higher than that of patients without artificial liver therapy.Secondary infection is an important cause of poor prognosis in patients with liver failure and complications and catheter indwelling time are independent risk factors for the treatment of infection in patients with liver failure.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.3

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