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Objective To explore the clinical characteristics and risk factors of healthcare-associated infection (HAI)in patients with severe viral hepatitis,so as to provide basis for clinical prevention and treatment of HAI. Methods Clinical data of 193 patients with severe viral hepatitis and admitted to a hospital from January 2012 to November 2015 were analyzed retrospectively,clinical characteristics and risk factors for HAI in patients were evaluated,all data were statistically analyzed.Results Among 193 patients,75 developed 112 times of HAI, incidence and case incidence of HAI were 38.86% and 58.03% respectively.The main infection sites were abdomi-nal cavity,lower respiratory tract,and gastrointestinal tract,infection rates were 33.93%,25.00% and 16.96%respectively.A total of 58 strains of pathogens were isolated,including fungi,gram-negative bacteria,and gram-positive bacteria,accounting for 53.45%,36.21%,and 10.34% respectively.Mulvariate logistic regression analy-sis showed that underlying diseases,use of glucocorticoid,invasive procedure,and white blood cell count<4.0×109/L were independent risk factors for HAI in patients with severe viral hepatitis (P<0.05).Conclusion Incidence of HAI in patients with severe viral hepatitis is high,risk factors are multiple.It is necessary to take targeted prevention measures during the treatment,so as to reduce the incidence of HAI.
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OBJECTIVE To study the dynamic changes and clinical significance of TNF-? and IL-10 of nosocomial infection in patients with severe viral hepatitis.METHODS The study included 40 patients with severe viral hepatitis,their nosocomial infection was treated with antibiotic therapy.Serum levels of TNF-? and IL-10 were measured at baseline and 5 d,10 d and 15 d after the first antimicrobial dose.The patients were divided into 2 groups: infection be controlled group and infection be not controlled group by therapeutic efficacy.RESULTS The serum concentrations of TNF? and IL-10 were elevated in all patients when compared with the healthy control group(P
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Objective To investigate the relation between the prognosis and complication of patients with severe viral hepatitis (SVH) Methods The incidences of different complications in 573 patients with SVH were analyzed The survival rates of SVH patients with different complications were compared Results Complications were diagnosed in 77 8% SVH patients The incidences of hepatic encephalopathy, infection, brain edema, gastrointestinal hemorrhage, and hepatorenal syndrome were 50 4%, 34 6%, 30 2%, 22 2%, and 21 8%, respectively The survival rate of SVH patients without complications was 78 7%, significantly higher than that of patients with complications (13 7%, P
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Objective To evaluate the effectiveness of prophylactic antibiotic therapy on nosocomial infection in patients with severe viral hepatitis,and inquire into its applied mechanism.Methods 159 cases of severe viral hepatitis were divided into groups according to clinical stage and the applied circumstance of antibiotic medicine;Group A:receiving no prophylactic antibiotics therapy,Group B intravenous injection of the third generation cephalosporins and Group C intravenous injection of the semisymthetic penicillins.All cases had no infection on admission and received no antibiotics for 7 days before entering hospital and had stayed in hospital over 72 hours.Results Nosocomial infection occurred in 76 patients among the 159 selected cases.The incidence of nosocomial infection of Group A,Group B and Group C was 56.16%(41/73),34.0%(17/50) and 50.0% (18/36),respectively.The occurring time of nosocomial infection of Group B in early,middle and late stage patients with severe viral hepatitis was significantly later than Group A.The incidence of nosocomial infection in middle and later stage patients was significantly lower,and the mortality was significantly decreased in middle stage patients.There was significantly difference between group A and B(P0.05).Conclusion Prophylactic usage of antibiotics of third generation cephalosporins can not only delay nosocomial infection but also decrease the incidence of nosocomial infection in middle and late stage patients and mortality in middle stage patients with severe viral hepatitis.
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Platelet aggregation ratio (PAR) was assessed in 35 patients with severe viral hepatitis (SVH) with Born's method.The PAR of normal individuals,patients with acute icteric hepatitis,and those with chronic active hepatitis were also studied to serve as controls.It was found that PAR decreased markedly in SVH patients,which was marked in the early stage of SVH,more marked in the intermediate stage,and most marked in the late stage.The changes of PAR were in negative correlation with those of serum total bilirubin,and in positive correlation with those of prothrombin activity.The reduction of PAR in SVH patients might be ascribed to the defect of platelets themselves as revealed by cross-over experiments.The results of this study indicate that PAR may be useful in judging the severity of SVH patients since the degree of PAR reduction parallels closely with the severity of liver damage.Finally the conditions of platelets in vivo and in vitro in SVH were discussed.
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Serial serum samples from 40 patients with severe viral hepatitis type B were tested by using ELISA. HBsAg/IgM complexes was detectable in 23 patients, but no activity was detected in normal controls. HBsAg/IgM complexes was not found or transiently existed in 24 patients ( 12 died deteriorated or persisted in severe disease, and 12 became recovery or improvement); 16 patients were constantly positive for HBsAg/IgM complexes (14 died, and 2 deteriorated). There is significantly difference between the two kinds of patients (P
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In order 10 correctly evaluate acid-base disturbances (ABD) in patients with severe viral hepatitis, 274 measurements of blood gases and electrolytes are analysed by the combination of ABD-PCF, AG, potential bicarbonate and chlorine (Cl~). According to the results of ABD-PCF, 142 times (51.8%) were diagnosed as simple ABD and 132 times (48.2%) as double ABD. When AG, potential bicarbonate and Cl- were used to analyse further, simple ABD was diagnosed 78 times only, double ABD 100 times, triple ABD 94 times, and quartet ABD 2 times only. Increased 64 times (48.5%) of mixed ABD were diagnosed by the combined method. This results suggests that the latter was important for correct evaluation of mixed ABD, especially for triple and quartet ABD. The incidences of complications and mortality were significantly higher in patients with mixed ABD than those with simple ABD.
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The report deals with autopsies of 30 hospitalized patients with clinical manifestations of severe viral hepatitis (SVH), who died of hepatic failure. Their age ranged from 8-57 years with an average of 27.9. There were 23 males, and 7 females in the group. The duration of the disease varied with different' , individuals, ranging from 1-96 months. Before onset of SVH, 73.3% of the cases had been afflicted with acute hepatitis or CAH. The clinical' course, therefore, was quite different from that .of fulminat variant.The pathological changes in the livers could be classified into 4 different types: subacute necrotic hepatitis (type Ⅰ ), necro-proliferative hepatitis (type Ⅱ), precirrhotic hepatitis (type Ⅲ), and cirrhotic hepatitis (type Ⅳ). Each of the 4types could be delineated with its own morphological features. However, overlaps in between two successional types (e.g. between type Ⅰ -Ⅱ, etc.) existed/morphology. These facts make it reasonable to postulate that each of the 4 types might represent a different stage in the progress of SVH.
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This paper is to report the results of comprehensive treatment for 78 patients with severe viral hepatitis(SVH). The overall survival rate was 39.74%, and the survival rates of subacute and chronic SVH were 48.39% and 34.04% respectively. Compared with the survival rate of 10-30% reported abroad and 27.9% of our previous report, the survival rate after comprehensive therapy was slightly improved.After analyzing the results, the authors suggest that besides early diagnosis, prompt treatment, intensive basic treatment, and energetic prevention ' and treatment of the complications, further exploration for new and effective therapeutic agents be of prime importance to improve the survival rate of SVH.
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Plasma fibronectin (PFn) was determined serially by both simple radial immunodiffusion (RID) and improved indirect hemoagglutination test (using gelatin-coated sheep RBC) in the serum of 30 patients with severe viral hepatitis (SVH),100 normal subjects,and 30 patients with chronic active hepatitis (CAH).Liver function,serum C3 and immunoglobulin (Ig) were determined simultaneously.Endotoxin was assayed by Limulus lysate test in 21 patients with SVH.The normal value of PFn was 284.31?45.56?g/ml and 1:30.64 (geometrical mean).The PFn level significantly decreased in patients with SVH.Significant correlations were found between PFn levels and the values of total serum bilirubin,prothrombin time,C3 and IgM.Low PFn levels were remarkably associated with the occurrence of endotoxeamia.Serial determinations of PFn in serum can reflect the severity of the illness and prognosis in the patients with SVH.
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This paper is to report the study of the microscopic and macroscopic he-morrheological changes and the conditions of the nail-fold microcirculation in 30 patients with severe viral hepatitis. Normal 'individuals, patients with acute icteric hepatitis, and those with chronic active hepatitis were employed as the controls.The changes observed in the patients with severe viral hepatitis were as follows: The reduced viscosity of the whole blood and the plasma viscosity increased markedly, the dispersion rate of the blood viscosity values increased as the clinical state of the patient became more severe, and the factors increasing the blood viscosity (namely, increase of the amount of immune globulin, pro-longation of the electrophoretic time of RBC, increase of RBC sedimentation rate), and the factors decreasing the blood viscosity (namely, decreases of he-matocrit reading, fibrinogen, and the aggregation ratio of platelets) existed simultaneously. The changes of the flow condition and velocity of the nail-fold microcirculation were in close correlation with the increase of blood viscosity and the severity of the disease.The causes and the mechanism of the above-mentioned changes were discussed.
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According to clinical manifestations, 122 cases of subacute and chronic severe viral hepatitis confirmed by pathologic examination, were divided into two types. The severe jaundice-ascites(SJ-A) type accounted for 93 cases (76.2%) and the subfulminant hepatic failure (SFHF) type 29 cases (23.8%), with a ratio of 3.2 : 1. For SFHF type, hepatic encephalopathy was the first prominent feature and ascites might or might not appeared later. Therefore, this type was most easily misdiagnosed as fulminant hepatitis. In comparison with SJ-A type, the average elevation of serum bilirubin was lower and the average depression of prothrombin activivty more remarkable in SFHF type, suggesting that the degree of hepatic necrosis was more severer and the progress to hepatic failure more rapid. The mortality of SFHF type (93.1%) was markedly higher than that of SJ A type (62.4%) (x2 = 7.488, P
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Fifteen patients with hepatocellular failure from viral hepatitis were treated with general combined therapy and transfusion" of homologous fetal hepatic cells (FLO for 36 times (group A). An additional 15 cases with hepatocellular failure from viral hepatitis were treated only with general combined therapy, as control (group B). Twelve cases of the group A were diagnosed by transcutaneous liver biopsy.The results showed that FLC suspension achieved satisfactory effects and those who received FLC rallied remarkably better than those who did not. The fatality rates of group A and B were 26.7% (4/15) and 60.0% (9/15) respectively. In group A after transfusion of FLC, the effects were mainly shown by the elevation of the prothrombin activity (elevated for 16.5% after 24 h and for 18.2% after 48 h in average), recovery from hepatic coma and improvement in the subjective symptoms and various hepatic function tests. In survivals of group A (11 cases), the serum bilirubin returned to normal more quickly than that of group B (5 cases), being 55.4?24.5 days and 119.7?54.9 days, respectively (P