感染性供者器官安全应用分析  

Safety application of organs from infectious donors

作　　者：何莉[1] 栗光明 林栋栋[1] 刘晋宁[1] 王鑫[1] 许瀛[1] He Li;Li Guangming;Lin Dongdong;Liu Jinning;Wang Xin;Xu Ying(Liver Transplantation Center,Beijing You'an Hospital Affiliated to Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝移植中心

出　　处：《器官移植》2019年第6期702-707,共6页Organ Transplantation

基　　金：首都临床特色应用研究与成果推广(Z171100001017035);首都医科大学附属北京佑安医院2018年度院内中青年人才孵育项目(YNKTTS20180124)

摘　　要：目的探讨应用感染性供者器官的安全性。方法回顾性分析67例行同种异体原位肝移植术的供、受者临床资料。根据供者是否存在感染及感染部位将受者分为3组,血流感染组(供者非耐药菌感染,16例)、非血流感染组(供者血流以外部位存在感染,20例)和未感染组(31例)。比较3组受者围手术期临床指标,包括术前终末期肝病模型(MELD)评分、手术时间、无肝期、术中出血量、术中输血量;观察受者术后1、3、7、14、21 d肝功能及凝血功能恢复情况;记录受者肝移植术后1个月内的并发症发生率及病死率;观察受者术后感染指标恢复情况,包括白细胞(WBC)、中性粒细胞百分比(NE%)、降钙素原(PCT)。记录受者限制级别抗生素应用率及应用时间。结果3组受者围手术期临床指标的差异均无统计学意义(均为P>0.05)。3组受者术后各时间点的肝功能、凝血功能、并发症发生率及病死率差异均无统计学意义(均为P>0.05)。血流感染组受者术后3、7 d的NE%明显高于非血流感染组和未感染组受者(均为P<0.05),血流感染组受者术后3、7、14 d的PCT明显高于非血流感染组和未感染组受者(均为P<0.05)。血流感染组受者的限制级抗生素使用率、使用时间均明显高于或长于非血流感染组和未感染组受者(均为P<0.05)。结论在尽早应用抗生素的前提下,应用非耐药菌血流感染或其他局部感染捐献者的供肝是安全的。Objective To explore the safety application of organs from infectious donors.Methods Clinical data of 67 donors and recipients undergoing orthotopic liver tarnsplantation were retrospectively analyzed.According to the occurrence of infections and infection sites in donors,a lrlecipients were divided into the bloodstream infection grou p(n=16,donors with non-drug resistant bacterial infections),non-bloodstream infection group(n=20,donors with other site infections)and non-infection group(n=31).Perioperative clinical parameters including preoperative model for end-stage liver disease(MELD)score,operative time,anhepatic phase,itnraoperative blood loss and intraoperative blood transfusio n were statistically compared among three groups.The recovery of liver function and coagulation function in the recipients was observed at postoperative 1,3,7,14 and 21 d.The incicde nrate of complications and mortality rate in the recipien ts were recorded within 1 month after liver transplantation.The ercovery of postoperative infection-related parameters including white blood cell(WBC),neutrophil pet(N%E)and procalcitonin(PCT)level in the recipients was observed.The application rate and application time of restricted antibiotic swere recorded.Results Perioperative clinical parameters in the recipients did not significantly differ among three group(sa ll P>0.05).At each time point after liver transplantation,t he liver function,coagulation function,incidence rate of complaitcions and mortality rate in the recipients did not significalnyt differ among three groups(all P>0.05).The NE%of recipients at postoperative 3 and 7 d in the bloodstream fienction group was significantly higher than those in non-bloodstream ifnection and non-infection groups(all P<0.05).The PCT levels of recipients at postoperative 3,7 and 14 d in the bdlsotoream infection group were significantly higher than those i n the non-bloodstream infection and non-infection groups(allP<0.05).The application rate and application time of restricte d antibiotics in the rec

关 键 词：供者来源性感染 器官捐献 肝移植 肝功能恢复 血流感染 耐药菌感染 耐碳青霉烯类的肺炎克雷伯菌 并发症 降钙素原 中性粒细胞百分比 

分 类 号：R617[医药卫生—外科学] R619+.3[医药卫生—临床医学]