重型肝炎患者肝移植术后细菌感染的防治  

The prevention and treatment of postoperative infection in severe hepatitis patients after liver transplantation

作　　者：蔡常洁[1] 陆敏强[1] 李敏如[1] 杨扬[1] 易慧敏[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,中山大学器官移植研究所,广州510630

出　　处：《中华普通外科杂志》2006年第11期804-806,共3页Chinese Journal of General Surgery

基　　金：国家科技部973计划项目(2003CB515500);广东省自然科学基金(4105344);广州市科技计划项目资助(200523-E0101)

摘　　要：目的探讨头孢吡肟治疗重型肝炎肝移植术后细菌感染的疗效。方法对2005年1月至2005年6月我中心46例重型肝炎肝移植患者术后细菌感染情况和头孢吡肟的疗效进行分析。结果本组患者术后细菌感染率为80．4％(37／46),共分离出细菌61株,其中革兰氏阴性(G-)杆菌占68．9％(42／62);革兰氏阳性(G+)球菌占31．1％(19／61)。G-杆菌对头孢吡肟的耐药率为33．3％,明显低于对头孢他啶(64．3％)、头孢曲松(76．2％)和头孢噻肟(61．9％)的耐药率(X2= 8．052,15．570,6．873,P<0．01)。经验治疗临床有效率为78．1％,患者使用过程中无明显不良反应。结论对肝移植术后常见G-杆菌的耐药率较多数三代头孢菌素低,头孢吡肟作为重型肝炎患者肝移植术后经验治疗用药是安全有效的。Objective To evaluate the efficacy and safety of cefepime in the treatment of bacterial infection in severe hepatitis patients after liver transplantation. Method From Jan 2004 to Jun 2004, 46 severe hepatitis patients received liver transplant in our center, Bacterial infection was monitored by bacteria culture and antibiotic sensitivity test. Result Bacterial infections were confirmed in 37 of 46 cases （80. 4% ）, with 61 pathogenic organisms being separated. Forty-two cases （68. 9% ） were with aerobic gram-negative （ G^- ） bacilli. Gram-positive （ G^＋ ） infection occurred in 31.1%. Resistant rate of G^- bacilli to cefepimein was 33.3% , significantly lower than that to ceftazidime （ 64. 3% ）, ceftriaxone （ 76. 2% ） and cefotaxime （61.9% ） （ x^2 = 8. 052,15. 570,6. 873, P 〈 0. 01 ）. Therapeutic effective rate is 78. 1% and there was no side effect related to cefepimein during the therapy. Condusion Cefepime is effective and safe in the treatment of bacterial infection in severe hepatitis patients after liver transplantation.

关 键 词：肝移植 细菌感染 头孢吡肟 

分 类 号：R657.3[医药卫生—外科学]