乙型肝炎肝硬化伴上消化道出血患者发生医院感染的相关因素多元回归分析

Multivariate regression analysis of related factors of nosocomial infection in patients with hepatitis B cirrhosis and upper gastrointestinal bleeding

关键词:  乙型肝炎  肝硬化  上消化道出血  医院感染  相关性分析  多元回归分析

Key words:  hepatitis B  liver cirrhosis  upper gastrointestinal bleeding  hospital infection  correlation analysis  multiple regression analysis

摘要:

采用多元回归分析法探讨乙型肝炎肝硬化伴上消化道出血患者发生院内感染的危险因素，为临床预防及控制提供参考。　方法　回顾性分析大连市第六人民医院2015年6月至2018年5月住院治疗的317例乙型肝炎肝硬化伴上消化道出血患者的临床资料，根据是否发生医院感染分为感染组和未感染组。统计感染病原菌分布和感染部位，采用单因素分析和Logistic回归模型分析院内感染发生的危险因素。　结果　317例患者中，发生医院感染75例，感染率为23.66%。共检出34株病原菌，其中革兰氏阴性菌18株（52.94%）、革兰氏阳性菌11株（32.35%）、真菌5株（14.71%）。感染分布最多的3个部位为腹腔、上呼吸道和下呼吸道。单因素分析结果显示感染组与未感染组患者在血红蛋白水平、血清蛋白水平、HBV-DNA水平、是否预防性使用抗菌药、是否采用三腔两囊管压迫止血以及是否采用胃镜套扎止血等方面差异具有统计学意义（P<0.05）。Logistic分析显示，年龄≥50岁、血红蛋白＜7 g/L、血清蛋白＜28 g/L、HBV-DNA≥500 cps/mL、未预防性使用抗菌药、未采用三腔两囊管压迫止血、未采用胃镜套扎止血是乙型肝炎硬化伴上消化道出血患者发生院内感染的危险因素。　结论　乙型肝炎肝硬化伴上消化道出血患者医院感染率较高，针对易感危险因素采取有效措施有助于控制和降低感染。

Abstract:

To explore the risk factors of nosocomial infection in patients with hepatitis B cirrhosis and upper gastrointestinal bleeding by multivariate regression analysis, and to provide references for clinical prevention and control. Methods The clinical data of 317 hepatitis B cirrhosis patients with upper gastrointestinal bleeding, who were hospitalized in our hospital from June 2015 to may 2018, were retrospectively analyzed. The patients were divided into infection group and non-infection group according to whether hospital infection occurred. The distribution and location of pathogenic bacteria were examined, and the risk factors of nosocomial infection were analyzed by single factor analysis and logistic regression model. Results Among the 317 patients, 75 had nosocomial infection with an infection rate 23.66%. A total of 34 pathogenic organisms was detected, including 18 gram-negative bacteria (52.94%), 11 gram-positive bacteria (32.35%) and 5 fungi (14.71%). The three most commonly infected areas were abdominal cavity, upper respiratory tract and lower respiratory tract. Single factor analysis revealed that there were statistically significant differences in hemoglobin level, serum protein level, HBV-DNA level, prophylactic use of antibiotics, usage of compression hemostasis with three lumens and two bladders and usage of endoscopic ligation hemostasis between infected and uninfected patients (P<0.05). Logistic analysis showed that the risk factors of nosocomial infection in patients with hepatitis B cirrhosis and upper gastrointestinal bleeding were age≥50 years old, hemoblobin<7 g/L, serum protein<28 g/L, HBV-DNA≥500 cps/mL, non-prophylactic use of antibiotics, non-use of compression hemostasis with three lumens and two bladders, and non-use of endoscopic ligation hemostasis. Conclusion The nosocomial infection rate of patients with hepatitis B cirrhosis and upper gastrointestinal bleeding is high. Taking effective measures to deal with the risk factors is helpful to control and reduce the infection.