肝移植患者术后感染相关危险因素分析  

Risk factors of postoperative infection in liver transplantation patients

作　　者：张莹[1] 韩东冬[2] 王华光[1] 刘丽宏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院药事部,北京100020 [2]首都医科大学附属北京朝阳医院肝胆外科,北京100020

出　　处：《中华临床感染病杂志》2016年第6期496-501,共6页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的探讨肝移植术后感染的可能危险因素，为有效防治术后感染提供依据。方法回顾性分析首都医科大学附属北京朝阳医院2011年1月至2014年12月113例接受肝移植手术患者的临床资料和实验室结果。根据感染情况将病例分为感染组和非感染组，对肝移植术后感染可能的危险因素进行Logistic多元回归分析。结果113例肝移植患者中，35例发生术后感染。单因素分析显示，术前住院天数、终末期肝病模型（MELD）评分、使用抗菌药物，术后呼吸机使用时间、重症监护病房住院天数、白蛋白用量、使用全胃肠外营养（TPN）天数、腹腔出血、空腹血糖、免疫抑制剂（FK506）血药浓度、预防感染用药天数和胸腔积液是肝移植患者术后感染的危险因素（t＝2.56、3.19、2.71和5.05，χ^2＝3.87、5.75、4.66和5.46，Z＝4.88、3.69、5.86和3.90，P〈0.05或P〈0.01）。多因素Logistic回归分析中，术前使用抗菌药物[OR＝35.03，95%可信区间（CI）：6.48～94.64，P〈0.01）、术后呼吸机使用时间（OR＝1.02，95%CI：1.01～1.04，P〈0.01）、术后全胃肠外营养天数（OR＝1.20，95%CI：1.07～1.35，P〈0.01）、术后空腹血糖（OR＝1.46，95%CI：1.10～2.16，P〈0.05）、术后预防感染用药天数（OR＝1.10，95%CI：1.33～1.86，P〈0.05）和胸腔积液（OR＝5.70，95%CI：1.02～31.84，P〈0.05）为肝移植患者术后发生感染的独立危险因素。结论临床上应根据肝移植患者术后感染的危险因素采取切实有效的预防和控制措施。Objective To investigate the risk factors of postoperative infection in patients with liver transplantation. Methods Clinical data and laboratory findings of 113 patients undergoing liver transplantation admitted in Beijing Chaoyang Hospital, Capital Medical University during January 2011 and December 2014 were retrospectively analyzed. Among 113 patients, postoperative infection occurred in 35 patients, multivariate Logistic regression analysis was performed to identify the risk factors of postoperative infection. Results Univariate analysis showed that length of hospital stay, model for end-stage liver disease （MELD） score, preoperative use of antibiotics, duration of postoperative respirator use, length of ICU stay, dosage of albumin, days of parenteral nutrition, intra-abdominal hemorrhage, fasting blood glucose, blood concentration of immunosuppressant （ FK506 ）, the duration of prophylactic use of antibiotics and pleural effusion were associated with postoperative infection （ t = 2.56,3.19,2.71 and 5.05 ; χ^2= 3.87,5.75,4.66 and 5.46;Z = 4.88,3.69,5.86 and 3.90;P 〈 0.05 or 〈 0.01 ）. Multivariable logistic regression analysis showed that preoperative use of antibiotics （OR = 35.03, 95% CI： 6.48 - 94. 64, P 〈 0.01 ）, duration of postoperative respirator use （ OR = 1.02, 95% CI： 1.01 - 1.04, P 〈 0.01 ）, days of parenteral nutrition （ OR = 1.20, 95% CI： 1.07 - 1.35 ,P 〈 0.01 ）, postoperative fasting plasma glucose（ OR = 1.46, 95% CI：1.10 - 2.16, P 〈 0.05 ）, the duration of prophylactic antibiotics use （ OR = 1.10,95% C1.1.33 - 1.86, P 〈0.05） , and pleural effusion（ OR = 5.70, 95% CI： 1.02 - 31.84, P 〈 0.05 ） were independent risk factors of postoperative infection. Conclusion Taken account of possible risk factors, effective prevention and control measures should be taken to prevent postoperative infection after liver transplantation.

关 键 词：肝移植 手术后期间 感染 危险因素 

分 类 号：R657[医药卫生—外科学]