肝移植术后肺部感染相关因素临床分析  

Risk factors and clinical outcomes of pneumonia in patients after liver transplantation

作　　者：孟稳利[1] 刘志华[1] 缪洁[1] 

机构地区：[1]河北医科大学第三医院ICU,河北石家庄050051

出　　处：《中国现代医学杂志》2013年第22期104-106,共3页China Journal of Modern Medicine

摘　　要：目的探讨肝移植术后患者肺部感染的相关危险因素。方法回顾性分析该院96例原位肝移植患者的临床资料,采用独立样本的T检验筛选出具有统计学意义的相关因素,然后行多因素非条件logistic回归分析。结果初步筛选的具有统计学意义的相关因素9个,分别为术前胆红素水平、术中总入量、术中液体总平衡、术中无肝期时间、机械通气时间、ICU滞留时间、术前白细胞计数和血红蛋白水平、术中血小板计数。经多因素非条件logistic回归分析,最终有统计学意义的危险因素有4个,按危险性大小依次为术前胆红素水平(OR 3.25),术中液体总平衡(OR 2.87),机械通气时间(OR 1.69),ICU滞留时间(OR 1.52)。结论肝移植术后患者肺部感染与多种因素有关,其中术前肝功能水平、术中液体平衡是主要危险因素。另外应尽量缩短机械通气和ICU滞留时间,有效控制院内感染。[ Objective ] To evaluate the outcome of post-LT （liver transplantation） pneumonia and identify poten- tial risk factors. [Methods ] From December 2002 to May 2011, 96 patients undergoing donor liver transplantation were enrolled in the prospective cohort. Their clinical and demographic variables, operative details, and post-LT complicationswere prospectively collected . Comparisons of continuous variables were performed by Student t test, the association between pneumonia and its risk factors weredetermined by univariate analysis as well as multivariate logistic regression modeling after adjusting for potential confounding factors. [Results] Univariate analysisresults showed that 9 relative factors （pre-LT bilirubin, pre-LT fluid volume, perioperative fluid balance, long anhepatic ar- terial phase, intensive care unit stay, mechanical ventilation duration, pre-LT leukocytes and hemoglobin, periopera- tive platelets） were associated with pneumonia. Multivariate logistic analysis identified 4 independent risk factors for post-LT pneumonia,which includingPre-LT bilirubin （OR 3.25）, perioperative fluid balance （OR 2.87）, perioperative fluid balance （OR 1.69）, mechanical ventilation duration （OR 1.52）. [ Conclusions ] Several modifiable risk factors were associated with the post-LT pneumonia mostly, among those identified factors, pre-LT bilirubin and perioperative fluid balance were the main risk factor for post-LT pneumonia. In addition, we should do what we can to reduce inten- sive care unit stay and mechanical ventilation duration in order to decrease the risk of hospital acquired pneumonia.

关 键 词：肝移植 肺感染 危险因素 多因素分析 机械通气 

分 类 号：R619.3[医药卫生—外科学] R639[医药卫生—临床医学]