肝移植后发生腹腔感染的危险因素分析  

Risk factors analysis of abdominal infection after liver transplantation

作　　者：申存毅[1] 薛峰[1] 李亚鹏 张晓刚[1] 张靖垚[1] 李宇[1] 刘学民[1] 吕毅[1] 王博[1] 刘昌[1] Shen Cunyi;Xue Feng;Li Yapeng;Zhang Xiaogang;Zhang Jingyao;Li Yu;Liu Xuemin;Lyu Yi;Wang Bo;Liu Chang(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华消化外科杂志》2021年第11期1184-1190,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81601672、81870445)。

摘　　要：目的探讨肝移植后发生腹腔感染的危险因素。方法采用回顾性病例对照研究方法。收集2015年1月至2018年12月西安交通大学第一附属医院收治的356例肝移植受者的临床资料;男273例,女83例;中位年龄为46岁,年龄范围为21~67岁。观察指标:(1)肝移植后发生腹腔感染及病原菌分布情况。(2)肝移植后发生腹腔感染的影响因素分析。(3)随访和生存情况。采用门诊和电话方式进行随访,了解受者术后1年总体生存率和死亡原因。随访时间截至2020年6月。正态分布的计量资料以x±s表示;偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。单因素分析采用χ^(2)检验、t检验、Mann⁃Whitney U检验、Fisher确切概率法。多因素分析采用Logistic回归模型。采用Kaplan⁃Meier法计算生存时间和生存率;采用Log⁃Rank检验进行生存分析。结果(1)肝移植后腹腔感染及病原菌分布情况:356例受者中,63例术后发生腹腔感染,发生率为17.70%(63/356)。63例术后发生腹腔感染受者中,41例发生于术后2周内,17例为多重耐药菌感染。63例术后发生腹腔感染的受者中,共分离培养细菌116株,其中革兰氏阴性菌52株,革兰氏阳性菌48株,真菌16株。(2)肝移植后发生腹腔感染的影响因素分析:单因素分析结果显示术前终末期肝病模型(MELD)评分、术前血清白蛋白、术前白细胞、术前凝血酶原时间、术前丙氨酸氨基转移酶、术前天冬氨酸氨基转移酶、手术时间、术中出血量、术后抗菌药物使用时间、术后肾衰竭、术后移植物功能延迟、术后重症监护室留置时间是影响肝移植后发生腹腔感染的相关因素(Z=-2.456,t=-1.982,Z=-3.193、-2.802、-2.336、-2.276、-2.116、-3.217,χ^(2)=15.807、10.395、6.750,Z=-4.468,P<0.05);再次肝移植、术后胆汁漏是影响肝移植后发生腹腔感染的相关因素(P<0.05)。多因素分析结果显示:术前MELD评分>20分、�Objective To investigate the risk factors for abdominal infection after liver transplantation(LT).Methods The retrospective case‐control study was conducted.The clinical data of 356 patients who underwent LT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2015 to December 2018 were collected.There were 273 males and 83 females,aged from 21 to 67 years,with the median age of 46 years.Observation indications:(1)abdominal infection after LT and distribution of pathogens;(2)analysis of risk factors for abdominal infection after LT;(3)follow‐up and survival.Follow‐up was performed using outpatient examination and tele‐phone interview to detect postoperative 1‐year survival rate and cases of death up to June 2020.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M(range).Count data were expressed as absolute numbers or percentages.Univariate analysis was conducted using the chi‐square test,t test,Mann-Whitney U test and Fisher exact probability.Multivariate analysis was done using the Logistic regression model.The Kaplan-Meier method was used to calculate sruvival time and survival rates.Log-Rank test was used for survival analysis.Results(1)Abdominal infection after LT and distribution of pathogens:63 of 356 recipients had abdominal infection after LT,with the overall incidence of 17.70%(63/356).Of the 63 recipients,41 cases had abdominal infection within postoperative 2 weeks,17 cases had multi-drug resistant organism infection.A total of 116 strains of bacteria were isolated from 63 recipients with abdominal infection,52 of which were gram‐negative bacteria,48 were grampositive bacteria,16 were fungi.(2)Analysis of risk factors for abdominal infection after LT:results of univariate analysis showed that preoperative model for end‐stage liver disease(MELD)score,preoperative serum albumin,preoperative leukocytes,preoperative prothrombin time,preoperative alanine aminotransferase,preoperative asp

关 键 词：腹腔感染 肝移植 病原菌 危险因素 分析 多重耐药菌感染 再次肝移植 

分 类 号：R657.3[医药卫生—外科学]