肝移植术后真菌感染危险因素分析  

The study of the risk factors of fungal infection after liver transplantation

作　　者：杨春华[1] 何晓顺[1] 陈娟[1] 欧阳彬[1] 朱晓峰[1] 陈敏英[1] 谢文峰[1] 陈丽[1] 郑东华[1] 钟韵[1] 陈雪霞[1] 管向东[1] 

机构地区：[1]中山大学附属第一医院重症医学科,广州510080

出　　处：《中华医学杂志》2012年第14期980-981,共2页National Medical Journal of China

摘　　要：目的探讨肝移植术后真菌感染的危险因素，为肝移植术后真菌感染的防治提供依据。方法回顾性分析2003年1月至2010年11月94例肝移植术后真菌感染患者的临床资料，取同期的未发生真菌感染的肝移植患者603例作对照，采用x^2检验和t检验对可能存在的真菌感染危险因素进行分析。结果肝移植术后真菌感染率为13．5％（94／697），真菌感染病死率为86．2％（81／94），感染菌种以白念珠菌居多，感染部位以肺部为主。感染组术后24h急性生理学和慢性健康状况评分高于对照组（26．0±5．4比21．5±4．7，P〈0．01）。感染组中原发性肝癌患者比例低于对照组（26．6％比45．8％），乙肝肝硬化、合并糖尿病患者比例高于对照组（23．4％比11．6％、9．6％比2．8％），器官功能不全、持续肠外营养时间较长、血糖控制不佳、机械通气及抗生素应用时间较长的患者比例均高于对照组（均P〈0．01）。结论术前原发病与术后病情危重程度、长期高血糖、长期抗生素应用和机械通气等可能是肝移植后真菌感染的重要危险因素。Objective To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation. Methods The clinical data of 94 cases of fungal infections after liver transplantation from January 1,2003 to November 30, 2010 at our hospital were collected as the infective group. A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group. X2 test and t test were utilized for the analysis of possible risk factors for fungal infection. Results Fungal infection rate was 13.5% （94/697） after liver transplantation and mortality rate of fungal infection 86.2% （81/94）. Candida albicans was the majority infective fungi. And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation Ⅲ （ APACHE Ⅲ） score of the infective group was significantly higher than that of the control group（26.0 ± 5.4 vs 21.5 ± 4.7, P 〈 0.01 ）. The number of patients with primary liver cancer was lower than that of the control group（26.6% vs 45.8% ,P 〈0.01 ）. The number of deeompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation （23.4% vs 11.6% ,9.6% vs 2.8% ,both P 〈 0.01 ）. The number of patients with postoperative mechanical ventilation over 10 days, postoperative antibiotics over 14 days, postoperative eardiopulmonary dysfunction and liver function recovery time over 7 days, parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group （ all P 〈 0. 01 ）. Conclusion Preoperative primary disease, postoperative disease severity, postoperative organ dysfunction, long-term mechanical ventilation, antibiotics and hyperglycemia, etc. may be the important risk factors of fungal infection after liver transplantation.

关 键 词：肝移植 真菌病 危险因素 

分 类 号：R657.3[医药卫生—外科学]