肝移植术后院内感染的临床研究  

Nosocomial infection in patients underwent orthotopic liver transplantation

作　　者：刘京涛[1] 马朋林[1] 李秦[1] 苏瑾文[1] 王宇[1] 赵金柱[1] 

机构地区：[1]解放军总医院第二附属医院ICU,北京100091

出　　处：《解放军医学杂志》2006年第7期729-730,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的调查肝移植术后院内感染情况,分析该类病人发生院内感染的高危因素和可能的预防措施。方法对56例肝移植术后病人的临床资料行回顾性分析。结果院内感染组APACHEⅡ评分、总胆红素明显高于非院内感染组,而血小板明显低于非院内感染组。二次手术及术前应用广谱抗生素病人例数院内感染组明显高于非院内感染组。术前广谱抗生素使用时间与院内感染发生密切相关,使用时间越长,院内感染发生率越高。病人年龄、术前Child-Pugh评分和血浆白蛋白水平两组比较无统计学差别。此外,与非肠球菌院内感染组比较,肠球菌感染组APACHEⅡ评分、总胆红素水平显著升高(P<0·01)。结论高APACHEⅡ评分、高胆红素血症、血小板下降以及手术前广谱抗生素使用时间与院内感染密切相关。Objective To investigate morbidity and analyze high risk factors of nosocomial infection in patients who underwent orthotopic liver transplantation （OLT） in our ICU, in order to draft possible preventive strategies. Methods The clinical data of 56 OLT patients from Apr 2002 to Dec 2004 were analyzed. Resulls Significantly high APACHE Ⅱ scores and total plasma bilirubin, low platelet count were found in patients with nosocomial infection. The number of patients who had received an additional operation and broad-spectrum antibiotics before OLT were greater in nosocomial infection （NI） group than in none-nosocomial infection （NNI） group. Notably, the longer the broad-spectrum antibiotics used before OLT, the higher the morbidity rate of nosocomial infection. No significant difference was found in age, Child-Pugh grade and plasma albumin level between the two groups. In addition, APACHEⅡ scores and total bilirubin level were significantly higher in patients acquired enterococcal infection than in those infected with other pathogenic microorganisms. Candusions High APACHE II score, high total bilirubin level, low platelet count and length of use of broad-spectrum antibiotics before OLT were closely associated with nosocomial infection. As an important indicator, change in total bilirubin level not only represented the liver function , but also was one of the high risk factors to nosocomial infection in patients undergoing OLT.

关 键 词：交叉感染 肠球菌属 肝移植 

分 类 号：R671[医药卫生—外科学]