慢加急性肝衰竭患者发生肺部感染的现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2020.10.014

摘要/Abstract

摘要：

目的探讨乙型肝炎病毒相关慢加急性肝衰竭（HBV related acute-on-chronic liver failure,HBV-ACLF）患者发生肺部感染的现状及其影响因素。方法回顾性分析2017年1月—2019年12月于上海市某三级甲等医院传染科住院治疗的238例HBV-ACLF患者的病历资料,统计HBV-ACLF患者发生肺部感染的情况,并分析其影响因素。结果238例HBV-ACLF患者,发生肺部感染患者53例,感染率为22.27%;Logistic回归分析显示,高龄、使用激素、长期使用抗生素是HBV-ACLF患者发生肺部感染的独立危险因素。结论 HBV-ACLF患者年龄越大、使用激素、长期使用抗生素导致其肺部感染率增高,在HBV-ACLF患者的治疗及护理过程中,应结合发生肺部感染的相关影响因素,采取针对性干预措施,从而降低HBV-ACLF患者的肺部感染率。

关键词: 乙型肝炎病毒, 慢加急性肝衰竭, 肺部感染, 影响因素分析, 护理

Abstract:

Objective To explore the current status and the influencing factors of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）. Methods A retrospective analysis was performed for the clinical data of 238 HBV-ACLF patients who were hospitalized in a tertiary hospital in Shanghai from January 2017 to December 2019,so as to analyze the current status and the influencing factors of pulmonary infection. Results Among 238 patients with HBV-ACLF,53 patients suffered from pulmonary infection,and the infection rate was 22.27%.Binary logistic regression demonstrated that age,use of hormones and long-term use of antibiotics were independent risk factors for HBV-ACLF patients complicated with pulmonary infection. Conclusion HBV-ACLF patients with the older age,the use of hormones and the long-term use of antibiotics can increase the risk of pulmonary infection. In the treatment and nursing care process of HBV-ACLF patients,targeted interventions should be taken into consideration of the relevant influencing factors of pulmonary infection,so as to reduce the pulmonary infection rate of HBV-ACLF patients.

Key words: Hepatitis B Virus, Acute-on-Chronic Liver Failure, Pulmonary Infection, Root Case of Analysis, Nursing Care

胡正翠,陈怡. 慢加急性肝衰竭患者发生肺部感染的现状及影响因素研究[J]. 中华护理杂志, 2020, 55(10): 1521-1525.

HU Zhengcui,CHEN Yi. Study on influencing factors of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Journal of Nursing, 2020, 55(10): 1521-1525.

图/表 2

参考文献 20

[1]	李珊珊, 段钟平, 陈煜, 等. 慢加急性肝衰竭诊治新思路与新方法[J/CD]. 临床肝胆病杂志, 2018,34(4):877-882.
	Li SS, Duan ZP, Chen Y, et al. New ideas and methods for the diagnosis and treatment of acute-on-chronic liver failure[J/CD]. J Clin Hepatol, 2018,34(4):877-882.
[2]	中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 现代医药卫生, 2018,34(24):3897-3904.
	Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association, Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association. Guideline for diagnosis and treatment of liver failure[J]. J Mod Med Health, 2018,34(24):3897-3904.
[3]	Zhao RH, Shi Y, Zhao H, et al. Acute-on-chronic liver failure in chronic hepatitis B:an update[J]. Expert Rev Gastroenterol Hepatol, 2018,12(4):341-350. DOI URL PMID
[4]	叶秋, 刘唯佳, 黄其密, 等. 乙型病毒性肝炎并发慢加急肝功能衰竭患者合并肺部感染的临床分析[J/CD]. 中华肺部疾病杂志(电子版), 2016,9(3):322-324.
	Ye Q, Liu WJ, Huang QM, et al. Clinical analysis of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure[J/CD]. Chin J Lung Dis(Electronic Edition), 2016,9(3):322-324.
[5]	陈明胜, 甘巧蓉, 江晓燕, 等. 乙型肝炎病毒相关慢加急性肝功能衰竭患者合并肺部感染的临床分析[J]. 中华传染病杂志, 2015,33(4):193-197.
	Chen MS, Gan QR, Jiang XY, et al. Clinical analysis of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chin J Infect Dis, 2015,33(4):193-197.
[6]	祖丽皮娅·艾合麦托合提. 重型肝炎合并肺部感染患者相关危险因素的分析以及防治对策[J]. 世界最新医学信息文摘, 2018,18(90):23-24,28.
	Zulipiya·Aihemaituoheti. Analysis of risk factors and control measures for severe hepatitis with pulmonary infection[J]. World Latest Medicine Information, 2018,18(90):23-24,28.
[7]	中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南[J]. 临床肝胆病杂志, 2019,35(1):38-44.
	Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association, Severe Liver Disease and Artificial Liver Group,Chinese Society of He. Guideline for diagnosis and treatment of liver failure[J]. J Clin Hepatol, 2019,35(1):38-44.
[8]	Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospita1-acquired and ventilator-associated pneumonia:2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society[J]. Clin Infect Dis, 2016,63(5):e61-e111. DOI URL PMID
[9]	中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018,41(4):255-280.
	Infection Group, Chinese Society of Respiratory Diseases,Chinese Medical Association.Guideline for diagnosis and treatment of Chinese adults with hospital-acquired and ventilator-associated pneumonia(2018)[J]. Chin J Tuberc Respir Dis, 2018,41(4):255-280.
[10]	吴冬霞, 贾海媛, 闫茗, 等. 应用激素治疗重症肝病继发血糖升高的观察与护理[J]. 北京医学, 2018,40(4):374-376.
	Wu DX, Jia HY, Yan M, et al. Observation and nursing of hyperglycemia induced by hormone therapy in severe liver diseases[J]. Beijing Medi J, 2018,40(4):374-376.
[11]	刘菲菲, 吴吉圆, 张海月, 等. 慢加急性乙型肝炎肝衰竭临床特征及血浆置换治疗对其预后的影响[J]. 实用肝脏病杂志, 2016,19(2):188-191.
	Liu FF, Wu JY, Zhang HY, et al. Clinical characteristics of patients with hepatitis B-induced acute-on-chronic liver failure and the effects of plasma exchanges on their prognosis[J]. J Prac Hepatol, 2016,19(2):188-191.
[12]	黎倍伶, 钟国涛, 陈金军. 自发性细菌性腹膜炎诊断和治疗现状[J]. 临床肝胆病杂志, 2019,35(9):2079-2081.
	Li BL, Zhong GT, Chen JJ. Current status of the diagnose and treatment of spontaneous bacterial peritonitis[J]. J Clin Hepatol, 2019,35(9):2079-2081.
[13]	林金华, 吴传喜, 姚耀梅. 脑梗死患者并发肺部感染相关因素及对预后的影响[J]. 中国医药科学, 2019,9(10):193-195,221.
	Lin JH, Wu CX, Yao YM. Related factors of patients with cerebral infarction complicated with pulmonary infection and its effect on prognosis[J]. Chin Medi Pharm, 2019,9(10):193-195,221.
[14]	陈潇, 张玉侠. 握力测量在肝脏疾病患者营养评估中应用的研究进展[J]. 中华护理杂志, 2017,52(4):469-473.
	Chen X, Zhang YX. Advance in the application of hand-rip dynamometry in nutritional assessment of patients with liver disease[J]. J Clin Nurs, 2017,52(4):469-473.
[15]	王宁, 庄芸香, 廖威, 等. 口服营养制剂对合并营养不良风险肝硬化失代偿患者生化指标和临床转归的影响[J]. 海军医学杂志, 2018,39(6):563-567.
	Wang N, Zhuang YX, Liao W, et al. Effects of oral nutritional supplements on the biochemical indexes and outcomes of patients with decompensated liver cirrhosis and malnutrition[J]. J Navy Medi, 2018,39(6):563-567.
[16]	孙丰凯, 王凯. 重视肝衰竭糖皮质激素的应用[J]. 世界华人消化杂志, 2015,23(29):4611-4616. DOI URL
	Sun FK, Wang K. Application of glucocorticoids in liver failure[J]. WCJD, 2015,23(29):4611-4616. DOI URL
[17]	沈燕, 周玉峰, 杨娟. 碳酸氢钠溶液不同漱口方案对恶性肿瘤化疗患儿口腔pH值的影响研究[J]. 中华护理杂志, 2017,52(12):1413-1417.
	Shen Y, Zhou YF, Yang J. The effects of different gargling methods of sodium bicarbonate on oral pH values in children with malignant tumors undergoing chemotherapy[J]. Chin J Nurs, 2017,52(12):1413-1417.
[18]	Mücke MM, Rumyantseva T, Mücke VT, et a1. Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality[J]. Liver Int, 2017,12:3218-3221.
[19]	曾竹君, 谢青. 慢加急性肝衰竭患者的感染问题:发生、特征及其对疾病进展和预后的影响[J]. 中华肝脏病杂志, 2018,26(1):6-9.
	Zeng ZJ, Xie Q. Development and features of infection in patients with acute-on-chronic liver failure and its influence on disease progression and prognosis[J]. Chin J Hepatol, 2018,26(1):6-9.
[20]	Society of Infectious Diseases,Chinese Medical Association. Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection[J]. J Clin Hepatol, 2018,34(9):1862-1872.