Đặc điểm tình trạng nhiễm trùng trên bệnh nhân xơ gan có bệnh não gan

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Tác giả: Hoàng Anh Khoa Nguyễn, Thị Khánh Tường Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.98

Bộ sưu tập: Metadata

ID: 339343

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- Đặt vấn đề: Nhiễm trùng là một yếu tố đặc biệt thúc đẩy bệnh não gan (BNG). Với tỉ lệ bệnh nhân (BN) xơ gan có BNG và nhiễm trùng có xu hướng gia tăng, nên việc nghiên cứu các chủng vi khuẩn (VK) hiện mắc và đặc điểm tình trạng nhiễm trùng trên BN xơ gan có BNG giúp ta hiểu rõ hơn về tỉ lệ nhiễm trùng, đặc điểm vi khuẩn thường gặp. Từ đó có thể đưa ra bước đầu hướng dẫn khả năng điều trị và dự phòng tốt hơn BNG trên BN xơ gan.- Đối tượng - phương pháp: Nghiên cứu cắt ngang. Cỡ mẫu 68 BN xơ gan có BNG điều trị tại khoa Nội tiêu hóa BV Nhân dân Gia Định. BN xơ gan được phân loại theo Child - Turcotte - Pugh. BN có BNG được phân loại C theo hướng dẫn AASLD và EASL 2014, phân độ theo WHC, ISHEN. Đối với BN có BNG tiềm ẩn (tối thiểu - độ 1), ta tiến hành đánh giá bằng thang điểm PHES (Psychometric hepatic encephalopathy score) trên các BN xơ gan. BN được phân loại tùy từng vị trí nhiễm trùng và tiến hành xác định VK nuôi cấy được trong tình trạng nhiễm trùng.- Kết quả: Độ tuổi trung bình của BN tham gia nghiên cứu 57,4 tuổi. Nam chiếm 70,60%. Thời gian mắc xơ gan trung bình 6,8 năm, nguyên nhân xơ gan đa phần do rượu 44%. Độ xơ gan theo Child - Turcotte - Pugh của các BN tham gia nghiên cứu được xếp loại C77,90%, loại B 23,10%. Phân độ BNG độ 2 có tỉ lệ cao nhất với 73,50%, BNG độ 3 17,70%, độ 1 và 4 cùng có tỉ lệ 4,40%.- Kết luận: Tỉ lệ BN xơ gan có BNG có tình trạng nhiễm trùng là 53%. Chỉ số INR ở nhóm BN nhiễm trùng cao hơn nhóm không nhiễm trùng và nồng độ albumin trong máu ở nhóm BN nhiễm trùng thấp hơn nhóm BN không nhiễm trùng, khác biệt có ý nghĩa thống kê với p <
0,05. Nồng độ NH3 tăng dần theo phân độ BNG từ độ 2 tới độ 4, khác biệt có ý nghĩa thống kê p <
0,05. Tỉ lệ phân lập xác định được VK ở mức trung bình (47%). Nhiễm trùng huyết chiếm tỉ lệ cao nhất (41,70%). Kế tiếp là viêm phúc mạc nhiễm khuẩn tự phát (VPMNKTP) và nhiễm trùng hô hấp với cùng tỉ lệ 30,60%. Escherichia coli là vi khuẩn được xác định nhiều nhất với 6 trường hợp và có trong các loại nhiễm trùng huyết, hô hấp, tiết niệu, VPMNKTP.Abstract- Introduction: Infection is a special motivating factor for hepatic encephalopathy. The ratio of infection of cirrhotic patients with hepatic encephalopathy tends to increase, so the study of existing bacteria strains and characteristics of infection in cirrhotic patients with hepatic encephalopathy helps us to better understand rate of infection, characteristics of typical bacteria. Then, it can provide an initial guide to better treatment and prevention of hepatic encephalopathy in cirrhotic patients.- Materials - Methods: A cross - sectional study of 68 cirrhotic patients with hepatic encephalopathy treated at Department of Gastroenterology, Gia Dinh People’s Hospital. Cirrhotic patients were classified according to Child - Turcotte - Pugh. Hepatic encephalopathy was classified type C according to AASLD and EASL 2014 guidelines, and graded according to WHC, ISHEN. For covert hepatic encephalopathy (minimal - grade 1), we used Psychometric hepatic encephalopathy score (PHES) to estimate all cirrhotic patients in the department. Patients are classified depending on the site of infection and the ability to culture bacteria.- Results: The mean age of patients participating in the study was 57.4 years old and 70.60% of the patients were male. The average duration of cirrhosis was 6.8 years. The most common cause of cirrhosis was alcohol 44%. Cirrhosis according to Child - Turcotte - Pugh of the patients in the study who was graded C and B occupied 77.90% and 23.10% respectively. Hepatic encephalopathy grade 2 presented the highest rate with 73.50% while grade 3 was at 17.70% and grade 1 and 4 showed the same rate of 4.40%.- Conclusions: The rate of infection in cirrhotic patients with hepatic encephalopathy was 53%. INR index in the group of infectious patients was higher than the non - infectious group. The blood albumin in the group of infectious patients was lower than the non - infectious group. The difference was statistically significant with p <
0.05. The concentration of NH3 gradually increased according to the hepatic encephalopathy classification from grade 2 to grade 4, p <
0.05. The rate of culture and identification of bacteria was 47%. Sepsis was the highest rate (41.70%). The second highest was spontaneous bacterial peritonitis and pneumonia with the same rate of 30.60%. Escherichia coli was the most identified bacteria with 6 cases and it presented in sepsis, pneumonia, urinary tract infections, spontaneous bacterial peritonitis. DOI: 10.59715/pntjmp.1.3.13

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