重型肝炎合并革兰阴性菌感染的预后及影响因素

摘要

目的 探讨重型肝炎合并革兰阴性菌感染的预后及影响因素,为有效防治提供指导.方法 回顾性分析2004年1月-2006年6月我院住院的重型病毒性肝炎合并革兰阴性菌感染220例的预后,以及性别、年龄、肝炎型别、各种其他合并症、感染部位及细菌类型对预后的影响.结果 重型肝炎合并革兰阴性菌感染占总体细菌感染的79.1%,总病死率为55.6%.年龄大于50岁者病死率更高;而急性、亚急性和慢性重型肝炎合并革兰阴性菌感染患者的病死率差异无统计学意义;血液感染的病死率高于呼吸道感染的病死率;大肠埃希菌的病死率明显高于克雷伯菌属及铜绿假单胞菌.结论 重型肝炎合并革兰阴性菌感染的预后较差,应高度重视高危人群,积极治疗以提高生存率.%Objective To investigate the prognosis and prognostic factors of severe hepatitis with gram-negative bacterial infection so as to provide guidance for its effective prevention and treatment. Methods A retrospective analysis was made of the prognosis of 220 cases of severe viral hepatitis with gram-negative bacterial infection, who were admitted to our hospital from Jan.2004 to Jun. 2006, and the influence of sex, age, type of severe hepatitis, complications, the sites of infection and species of bacteria on the pronosis. Results The severe hepatitis patients with gram-negative bacterial infection accounted for 79.1％ among the patients with bacterial infections and the mortality rate was 55.6％. The patients aged more than 50 years had the highest mortality rate. There were no significant differences in the mortality rates among the patients with acute severe hepatitis, subacute severe hepatitis and chronic severe hepatitis. The patients with blood infection had a more increased mortality rate compared with those with respiratory infection. The patients with Escherichia coli infection had higher mortality rate than those with Klebsiella and Pseudomonas aeruginosa infections. Conclusions The severe hepatitis patients with gram-negative bacterial infection have poorer prognosis. The high-risk patients should be paid much attention and provided with active treatment modalities to improve the survival rate.