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目的分析肝硬化败血症患者的病原特点及预后,为有效救治提供依据。方法回顾分析我院肝硬化住院患者中有败血症临床征象并血培养阳性的病例资料,进一步分析其感染病原特点及预后。结果 2011—2013年进行血培养的肝硬化患者12 307例,血培养阳性1405例(11.42%)。病原菌包括革兰阴性杆菌(729株,51.89%)、革兰阳性球菌(604株,42.99%)、真菌(51株,3.63%)及其他(21株,1.49%)。败血症组中腹腔穿刺(25.69%)、肝癌有创治疗(18.65%)、静脉留置管(16.65%)、留置导尿管(16.16%)及糖尿病(5.12%)的比例明显高于对照组(P<0.05);革兰阴性杆菌感染组病死率(19.34%)明显高于革兰阳性球菌组(6.46%)(P<0.05);鲍曼不动杆菌感染病死率(56.52%)和铜绿假单胞菌感染病死率(58.62%)明显高于大肠埃希菌(30.23%)(P<0.05)。结论肝硬化败血症以革兰阴性杆菌感染为主,不同种类感染病原的预后不同,穿刺、肝癌有创治疗、插管及糖尿病患者更容易发生败血症。
Objective To analyze the pathogenic features and prognosis of patients with cirrhosis and sepsis and provide evidence for effective treatment. Methods Retrospective analysis of hospitalized patients with cirrhosis in our hospital have clinical signs of sepsis and blood culture positive case data to further analyze the characteristics and prognosis of the infected pathogens. Results A total of 12 307 liver cirrhosis patients were enrolled in blood culture in 2011-2013, and 1405 (11.42%) were positive for blood culture. Pathogens include Gram-negative bacilli (729 strains, 51.89%), Gram-positive cocci (604 strains, 42.99%), fungi (51 strains, 3.63%) and others (21 strains, 1.49%). The proportion of abdominal puncture (25.69%), invasive treatment of hepatocellular carcinoma (18.65%), intravenous catheterization (16.65%), indwelling catheterization (16.16%) and diabetes mellitus (5.12%) were significantly higher in the sepsis group than in the control group <0.05). The mortality of Gram-negative bacilli infection group (19.34%) was significantly higher than that of Gram-positive cocci group (6.46%) (P <0.05). The mortality of Acinetobacter baumannii infection was 56.52% The case fatality rate (58.62%) was significantly higher than that of Escherichia coli (30.23%) (P <0.05). Conclusions Gram-negative bacilli are the main cause of liver cirrhosis sepsis. The prognosis of different kinds of infectious pathogens is different. Puncture and invasive treatment of liver cancer are more likely to occur in patients with intubation and diabetes, and sepsis is more likely to occur.