本文選題：肝衰竭　切入點：人工肝支持治療　出處：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:分析人工肝支持治療肝衰竭患者發(fā)生感染的相關(guān)危險因素,為臨床醫(yī)師采取有效措施,降低感染率,提高肝衰竭患者生存率提供依據(jù)。方法:收集2012年1月至2016年11月蚌埠醫(yī)學(xué)院第一附屬醫(yī)院感染科住院診斷為肝衰竭患者的臨床資料,如性別、年齡、肝功能、凝血功能、導(dǎo)管留置時間、是否應(yīng)用抗生素、是否合并并發(fā)癥、肝衰竭類型、Child-Pugh評分、MELD評分、外周血白細胞、中性粒細胞計數(shù)、血小板計數(shù)等。將患者分為人工肝組和非人工肝組,非人工肝組采用內(nèi)科綜合治療,人工肝組采用內(nèi)科綜合治療聯(lián)合人工肝支持治療�；仡櫺苑治鰞山M療效和感染差異;進一步將人工肝組分為感染組和非感染組,采用回歸分析方法尋找人工肝治療肝衰竭患者繼發(fā)感染的相關(guān)危險因素。結(jié)果:ALSS組ALT、AST、TBIL較基線水平顯著下降,CHE、ALB、PTA較基線水平顯著上升;非ALSS組ALT、AST、TBIL較基線水平下降,ALB、PTA較基線水平明顯上升,差異具有統(tǒng)計學(xué)意義。CHE治療前后的差異無統(tǒng)計學(xué)意義。ALSS組ALT、AST、CHE、TBIL、PT、PTA治療前后下降或上升幅度優(yōu)于非ALSS組,差異有統(tǒng)計學(xué)意義(P0.05)。ALSS組和非ALSS組好轉(zhuǎn)率分別為53.04%和44.29%,差異無統(tǒng)計學(xué)意義(P0.05)。36.08%(92/255)的肝衰竭患者出現(xiàn)感染,ALSS組和非ALSS組感染率分別為40.87%(47/115)和32.14%(45/140),兩組間差異無統(tǒng)計學(xué)意義(χ2=2.085,P0.05)。常見感染部位為下呼吸道(40.17%)、腹腔(27.45%)、上呼吸道(11.76%)、腸道(7.84%)、血流(5.88%)。感染患者中17.39%表現(xiàn)為兩部位感染。單因素logistic分析Child-Pugh分級、MELD評分、PTA、預(yù)防性應(yīng)用抗菌素、導(dǎo)管留置時間以及合并并發(fā)癥是ALSS組肝衰竭患者發(fā)生感染的危險因素(OR值分別為1.051、1.019、0.968、0.128、1.114、5.170),多因素logistic回歸分析表明合并并發(fā)癥和導(dǎo)管留置時間是ALSS組感染患者主要危險因素(OR值分別為11.590和1.253)。結(jié)論:內(nèi)科綜合治療能夠有效改善肝衰竭患者的肝功能及凝血功能,聯(lián)合人工肝支持治療療效更好;人工肝治療肝衰竭患者感染率高于未行人工肝治療者,繼發(fā)感染是肝衰竭患者預(yù)后不佳的重要原因;合并并發(fā)癥和導(dǎo)管留置時間是人工肝治療肝衰竭患者感染的獨立危險因素。
[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.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.3

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