原位肝移植术后感染分析  

Postoperative infection in patients undergoing orthotopic liver transplantation

作　　者：沈英皓[1] 樊嘉[1] 周俭[1] 吴志全[1] 邱双健[1] 黄晓武[1] 孙健[1] 王婷[1] 史颖弘[1] 

机构地区：[1]复旦大学肝癌研究所复旦大学附属中山医院普外科,上海200032

出　　处：《中华普通外科杂志》2007年第9期653-655,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨原位肝移植术后感染的特点及其易感因素，提高肝移植术后感染的诊治水平。方法 对250例原位肝移植术后感染患者的资料进行了回顾性分析，以术前、术中及术后主要的临床和实验室指标作为观察对象，分析感染组和非感染组间的差别。结果 250例原位肝移植患者术后发生感染的共163例，感染率为65.2%。最常见感染部位依次为血液、泌尿道和呼吸道。单个部位感染91例，两个部位感染45例，多个部位感染共27例。最常见为细菌感染，约89.6% （146/163），其中单一细菌感染62例，两种细菌感染27例，多种细菌同时感染19例。其次为真菌感染，占27.0%（44/163），44例中38例患者同时伴有细菌感染。病毒感染6.7%（11/163）。大部分感染均发生在围手术期内。Logistic回归分析表明肝移植患者年龄大于60岁、术前肝功能Child-Pugh C级、手术时间、术中输血总最〉1000ml、术后胸水、重症监护室（ICU）住院天数是术后感染的独立危险因素。结论 原位肝移植术后感染率高，多部位、多种病原菌的混合感染以及多重耐药菌日益增多。应重视对感染易感因素的控制，降低移植术后感染的发生率。Objective To investigate the characteristics of infection and susceptible factors after orthotopic liver transplantation （OLT）. Methods From April, 2001 to August, 2005, the clinical data of 250 post liver transplantation cases were retrospectively studied in order to analyse the difference between the patients with infection and those without infection. Results Infections developed in 163 （65.2%） cases. Blood stream, urethra and respiratory tract were the most common infectious site. Ninety-one patients had infection involving single organ or system, 45 had infections compromising two organs or systems and 27 had infections involving multiple organs or systems. Bacteria infections were most common, accounting for 89. 6% （146/163） , followed by fungal infection in 44 cases （27.0%）, and virus infection accounting for 6. 7% （11/163）. The infection caused by one kind of bacteria in 62 patients, two kinds of bacteria in 27 patients and multiple bacteria in 19 patients. Thirty-eight patients among the 44 patients with fungal infection also had bacteria infection. Most infections developed within the first month after liver transplantation. Logistic regression analysis suggested that patients over 60 years old, liver function of Child-Pugh grade C, long time operation, blood transfusion more than 1000 ml, postoperative pleural effusion and postoperative ICU stay were independent risk factors of infection after OLT. Conclusions The infection rate was high after OLT. Infections involving multiple systems or organs, caused by multiple pathogens or multiple- antibiotic- resistant bacteria are common. OLT patients were extraodinarily susceptible to infection when the above risk factors exist.

关 键 词：肝移植 感染 

分 类 号：R686[医药卫生—骨科学]