原位肝移植术后细菌感染的防治  

Prevention and Treatment of Bacterial Infection Occurred after Orthotopic Liver Transplantation

作　　者：牛秀峰[1] 刘军[1] 

机构地区：[1]山东大学山东省立医院器官移植中心,肝胆外科,济南250021

出　　处：《中国普外基础与临床杂志》2008年第3期162-165,179,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：山东省优秀中青年科学家基金(项目编号:2005BS03006)

摘　　要：目的探讨原位肝移植术后细菌感染的特点、易感因素,总结防治经验。方法回顾性分析我院79例原位肝移植的临床资料,对感染部位、常见致病菌、耐药情况和导致细菌感染的危险因素进行分析。结果全组32例发生细菌感染,感染率为40.5%,感染部位以肺部、腹腔及血液多见。感染菌株中以大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯杆菌、表皮葡萄球菌及肠球菌为主。恢复饮食时间延长(>5d)、术前肝功能C级、低蛋白血症及术后持续高血糖(>11.0 mmol/L)是感染的危险因素,肠道去污治疗是预防细菌感染的保护性因素。结论肝移植术后细菌感染是严重并发症之一,尽可能地减少各种危险因素,有效预防及早期确诊和治疗是防治细菌感染的关键。Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation （OLT） and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two （40.5%） out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function （〉5 d）, poorly preoperative liver function （Child C grade）, hypoproteinemia and persistent postoperative hyperglycemia （〉 11.0 mmol/L）. Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment.

关 键 词：肝移植 术后并发症 细菌感染 

分 类 号：R657.3[医药卫生—外科学] R619.3[医药卫生—临床医学]