肝移植术后肺部感染60例临床分析  

Clinical analysis of 60 cases of pulmonary infection aft erliver transplantation

作　　者：郭海英[1] 张杏怡[1] 蔡春[1] 王妍[1] 周新[1] 彭志海[2] 

机构地区：[1]上海交通大学附属第一人民医院呼吸科,200080 [2]上海交通大学附属第一人民医院普外科,200080

出　　处：《中国抗感染化疗杂志》2004年第6期328-331,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 :探讨肝移植术后肺部感染的防治。方法 :对我院 2 0 0 1年 1月至 2 0 0 3年 11月 10 8例肝移植术后发生肺部感染的 6 0例进行回顾性分析。结果 :本组患者肺部感染的发病率为 5 5 .6 % (6 0 / 10 8)。首次发生肺部感染的时间为术后 (14 .1±12 .4 )d。 6 0例中右侧肺炎 30例 ,左侧肺炎 11例 ,双侧肺炎 19例 ,其中 4 7例患者合并单侧或双侧胸腔积液。 6 0例患者的痰培养中分离出革兰阴性杆菌及革兰阳性球菌各 4株 ,真菌 5株 ;5 3例曾作血培养 ,共分离出革兰阴性杆菌 1株 ,革兰阳性球菌2株 ;10例接受气管插管机械通气治疗患者的气道吸引物分离出革兰阴性杆菌 4株 ,革兰阳性球菌 2株 ,真菌 1株 ;胸腔积液标本中分离出革兰阴性杆菌 1株 ,革兰阳性球菌 2株。 2 8例患者血清抗 CMV IgG阳性 ,2例患者血清抗 CMV IgM阳性。CD4 /CD8<1.2者 18例。 6 0例患者术后均使用了常规剂量的糖皮质激素、麦考酚酸酯、环孢素A或FK5 0 6等免疫抑制剂治疗。移植术前后常规应用预防性抗生素 ,发生肺部感染而尚未确定病原体时 ,抗感染药经验治疗。 6 0例患者中 5 3例 (88.3% )好转 ,7例 (11.7% )死亡。结论 :肝移植后肺部感染病死率较高。细菌、真菌及病毒等是主要的病原体。应仔细观察 ,早留标本 ,早期诊断 ,早期治疗 ,合?Objective: To explore the prevention and t reat ment of pulmonary infection after liver transplantation. Methods: The clinical data of 60 cases of pulmonary infection after liver transpla n tation in our hospital from January 2001 to November 2003 were analyzed retrospe ctively. Results: The incidence of pulmonary infection in th is group of patients was 55.6% (60/108). Among 60 cases, 46 were males and 14 fe males. The average age was (47±8) years. The mean onset time of the first pulmo nary infection after operation was (14.1±12.4) days after surgery. Thirty patie nts were diagnosed as right pneumonia, 11 as left pneumonia, and 19 bilateral pn eumonia. Forty seven patients were complicated with unilateral or bilateral pleu ral effusion. Four gram-negative organisms, 4 gram-positive organisms and 5 fu ngi were isolated from sputum and one gram-negative and 2 gram-positive organi sms were isolated from blood. Four gram-negative, 2 gram-positive bacteria and 1 fungus were isolated from endotracheal exudates. One strain of gram negative and 2 of gram positivse bacteria were isolated from pleural effusion. Serum anti -CMV-IgG was positive in 28 cases and anti-CMV-IgM positive in 2 patients. T he ratio of CD4/CD8 were less than 1.2 in 18 cases. Normal dosage of glucocortic oids, mycophenolic acid, cyclosporin A or FK506 were given to all 60 patients. P rophylactic antibiotics were given pre- and post- transplantation. Empirical a nti-infective drugs were used. 88.3% (53/60) of these patients improved, 7 (7/ 60, 11.7%) died. Conclusions: The mortality of pulmonary i nf ection after liver transplantation is high. Bacteria, fungi and viruses are the major pathogens. Patients must be observed carefully after transplantation. Samp le should be taken as soon as possible for the purpose of early diagnosis, early treatment and rational use of antibiotics. [

关 键 词：肝移植 肺部感染 

分 类 号：R657.3[医药卫生—外科学]