【摘要】：目的： 研究肝硬化并發(fā)肺部感染的影響因素、病原菌種類及臨床特點(diǎn)和倍能的治療效果,探討肝硬化并發(fā)肺部感染的影響因素是否可以作為并發(fā)肺部感染獨(dú)立的影響因素,研究肝硬化并發(fā)肺部感染與機(jī)體內(nèi)細(xì)菌和真菌的相關(guān)性,最后探討了伏立康唑和倍能聯(lián)合治療肝硬化并發(fā)肺部感染的效果,為臨床早期診斷和治療肝硬化并發(fā)肺部感染提供新的實(shí)驗(yàn)依據(jù)。 方法： 1)選擇了518例肝硬化患者為研究對(duì)象,通過對(duì)以往病人的性別、年齡、住院時(shí)間、肝硬化child-pugh分級(jí)、合并基礎(chǔ)疾病(糖尿病、慢性心肺疾病等情況)的并發(fā)癥、隨訪等多因素進(jìn)行回顧性總結(jié)分析； 2)選擇了肝硬化患者462人為研究對(duì)象,分別觀察了患者的咳嗽或咯痰癥狀,雙側(cè)或單側(cè)肺部有濕Up音或叩診濁音,X線顯示肺部存有滲出性病灶,發(fā)熱,體溫超過38℃,外周血WBC10X109/L,以不同時(shí)間培養(yǎng)同種深部痰病原菌2次以上為陽(yáng)性等臨床癥狀進(jìn)行了患者體內(nèi)病原菌種類及臨床特點(diǎn)的分析； 3)選擇了53例肝硬化合并肺部感染患者為研究對(duì)象,對(duì)患者進(jìn)行伏立康唑和倍能聯(lián)合治療和倍能單獨(dú)治療對(duì)比分析,以患者癥狀的緩解程度和肺炎性病灶的吸收消散情況為指標(biāo)進(jìn)行分析這兩種藥的治療效果。 結(jié)果： 1)本文研究肝硬化患者518例,肺部感染并發(fā)的患者有144例,發(fā)病率為27.79%。①child-pugh分級(jí)為C級(jí),該類患者肝功能受損嚴(yán)重,機(jī)體內(nèi)免疫蛋白、白蛋白及體液因子減少,門靜脈高壓及側(cè)支循環(huán)形成機(jī)體免疫力明顯下降。②中老年患者(≥60歲)相比于年輕患者而言更易并發(fā)肺部感染。③病毒性肝炎引發(fā)的肝硬化比其他原因?qū)е碌母斡不锌赡芤l(fā)肺部感染。④嘔血、誤吸、PPI大量使用等因素使肝硬化并發(fā)上消化道出血患者的消化道細(xì)菌發(fā)生遷移,常常會(huì)引發(fā)或加重肺部感染。⑤患有糖尿病,心腦血管疾病以及慢性阻塞性肺病等肝硬化患者也會(huì)引發(fā)肺部感染。⑥住院時(shí)間越長(zhǎng),外源性細(xì)菌的感染幾率增大,患者肺部的感染幾率也逐漸增大。各因素之間相互獨(dú)立。 2)有7例患者沒有臨床癥狀占10.4%,但胸部X線檢測(cè)發(fā)現(xiàn)肺部出現(xiàn)感染。67例患者中,對(duì)48例患者進(jìn)行了機(jī)體內(nèi)深部痰的致病菌培養(yǎng),其中36例為陽(yáng)性,陽(yáng)性率75.0%。共分離出病原菌78株,包括11種細(xì)菌64株,以革蘭氏陰性菌為主,其中銅綠假單胞菌24株,占30.8%,為主要致病菌；6種真菌14株。其中8例患者存在兩種或兩種以上病原菌混合感染。 3)使用伏立康唑和倍能聯(lián)合治療患者的治愈率為33.3%,患者的顯效率為63.0%,總有效率為96.3%；而單獨(dú)使用倍能聯(lián)合治療患者的治愈率19.2%,患者的顯效率為57.7%,總有效率為76.9%。伏立康唑和倍能聯(lián)合治療效果明顯優(yōu)于倍能單獨(dú)治療的治療效果,差異有統(tǒng)計(jì)學(xué)意義(P0.05),患者治療的前后肝功能不存在異常狀況。 結(jié)論： 1) child-pugh分級(jí)、年齡、患有其他基礎(chǔ)病、病情嚴(yán)重、并發(fā)癥、住院時(shí)間等獨(dú)立性多因素對(duì)患者的病情均有影響； 2)患者體內(nèi)的病原菌種類較多,但出現(xiàn)易于出現(xiàn)混合菌治病感染的狀況； 3)伏立康畔和倍能聯(lián)合治療的治療效果優(yōu)于倍能單獨(dú)治療。
[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，

本文編號(hào)：2329696