影响移植后肾功能恢复的感染因素及对策  

Infection factors affecting the recovery of kidney function after kidney transpluntation and the Countermeasures

作　　者：沈彬[1] 门同义[1] 王建宁[1] 张晓明[1] 杨吉伟[1] 李现铎[1] 陈冬冬[1] 唐冠宝 郭学文 陈浩 

机构地区：[1]山东大学附属千佛山医院泌尿外科,济南250014

出　　处：《中华器官移植杂志》2017年第9期550-554,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨感染因素在器官捐献供肾移植术后肾功能的影响及可能的对策。方法回顾性分析2014年1月至2016年12月间山东大学附属千佛山医院移植中心137例肾移植的临床资料，按照围手术期预防感染方案分为2组，42例受者术后常规应用头孢类或青霉素类预防感染2周，95例受者术后应用碳青霉烯类＋米卡芬净预防感染2周，观察2组受者术后感染的发生率，感染的发生时间、病原体；供、受者的年龄，供者的死亡原因，供、受者围手术期病原菌检测（器官保存液、引流液、尿液、痰液等标本），受者的急性排斥反应、移植肾功能恢复延迟（DGF）、糖尿病以及免疫抑制剂使用等情况。结果术后早期（2周内）应用碳青霉烯类＋米卡芬净组感染发生率为12.6%，应用头孢类或青霉素类组感染发生率为19.4%，差异有统计学意义（P〈0.05）。应用碳青霉烯类＋米卡芬净预防感染组在引流液、尿液、痰液等标本的病原体阳性检出率均较应用头孢类或青霉素类组低（P〈0.05）。术后2周内应用碳青霉烯类＋米卡芬净预防感染组检出细菌、真菌的百分率较少（P〈0.05），在病毒的检出上两组差异无统计学意义（P〉0.05）。术后2周至半年内两组间检出各类病原体的总体差异无统计学意义（P〉0.05）。供者感染、急性排斥反应、DGF、合并糖尿病是术后受者感染的危险因素（P〈0.05）。结论应用碳青霉烯类＋米卡芬净可降低器官捐献供肾移植术后早期受者感染的发生率，供者感染、急性排斥反应、DGF、糖尿病是术后受者感染的危险因素。ObjectiveTo investigate the influence of infection factors on kidney transplantation after organ donation and possible countermeasures.MethodsThirty-seven cases of kidney transplantation in Organ Transplantation Center of Qianfoshan Hospital Affiliated to Shandong University from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into two groups according to perioperative infection prevention programs： 42 patients with postoperative routine use of cephalosporins or penicillin for 2 weeks, and 95 patients with postoperative application of carbapenems ＋ micafungin. Postoperative infection rate, occurrence time, pathogen infection; donor age, perioperative pathogens of donor and receptor （organ preservation solution, drainage fluid, urine, sputum samples）, acute rejection, delayed graft function （DGF）, diabetes mellitus, and the use of immunosuppressive agents were recorded.ResultsThe infection rate in carbapenem ＋ micafungin group was 12.6%, and the infection rate in cephalosporin or penicillin group was 19.4% （P〈0.05）. Pathogen positive detection rate of the drainage fluid, urine and sputum was lower in carbapenems ＋ micafungin group than that in cephalosporins or penicillin （P〈0.05）. Within 2 weeks after operation, the detection rate of bacteria and fungi in the carbapenems ＋ micafungin infection prevention group was lower than that in the control group （P〈0.05）. There was no significant difference in the detection of viruses （P〉0.05）. There were no significant differences in the detection of pathogens among the two weeks to six months after surgery （P〉0.05）. Donor infection, acute rejection, DGF, and diabetes mellitus were the risk factors for postoperative infection （P〈0.05）.ConclusionThe application of carbapenems and micafungin can reduce the incidence of infection for the early stage of DCD kidney transplantation. Donor infection, acute rejection, DGF and diabetes mellitus are all risk factors for the postoperative infe

关 键 词：感染 肾移植 肾功能 移植物功能延迟 心脏死亡 

分 类 号：R699.2[医药卫生—泌尿科学]