肝移植手术后肺部感染的危险因素分析  

Risk factors for postoperative pulmonary infection undergoing liver transplantation

作　　者：崔丽娜 魏昌伟 吴丹[2] 吴安石[2] CUI Lina;WEI Changwei;WU Dan;WU Anshi(Department of Anesthesiology,Huairou Hospital,Beijing Hospital of Traditional Chinese Medicine,Beijing 101400,China)

机构地区：[1]北京中医医院怀柔医院麻醉科,101400 [2]首都医科大学附属北京朝阳医院麻醉科

出　　处：《临床麻醉学杂志》2024年第1期13-17,共5页Journal of Clinical Anesthesiology

基　　金：北京市医管局“扬帆”计划(ZYLX201822)。

摘　　要：目的探讨肝移植手术患者术后肺部感染的危险因素。方法回顾性分析2005年6月至2013年6月于三家临床医疗中心首次行原位肝移植手术的1358例患者的临床资料。根据患者术后30 d内是否发生肺部感染将患者分成两组:感染组和非感染组。收集术前资料、术中资料及术后资料,采用单因素分析及二元Logistic回归分析肝移植术后肺部感染的危险因素。结果肝移植手术后有316例(23.3%)发生肺部感染,其中有21例(6.7%)死亡。与非感染组比较,感染组术前诊断为慢性重型肝炎、肝癌、丙型肝炎肝硬化、先天性肝脏疾病及肝衰竭、术前合并肝肾综合征、肝昏迷、糖尿病的比例、术前肌酐浓度明显升高(P<0.05),术前总蛋白、白蛋白浓度明显降低(P<0.05),无肝期时间、术后苏醒时间及术后拔管时间明显延长(P<0.05),术中失血量明显增加(P<0.05),术中尿量明显减少(P<0.05),术中使用去氧肾上腺素、阿托品、利多卡因及呋塞米的比例明显降低(P<0.05),术后死亡率明显升高(P<0.05)。二元Logistic回归分析显示:慢性重型肝炎、丙型肝炎肝硬化、肝衰竭、术前合并糖尿病、术中失血量>1900 ml、术后苏醒时间>7.3 h是肝移植患者术后肺部感染的危险因素;手术方式(经典非转流原位肝移植)、术中使用利多卡因、术前总蛋白>64.6 g/L、术中尿量>1800 ml是肝移植手术患者术后肺部感染的保护因素。结论术前诊断慢性重型肝炎、丙型肝炎肝硬化、肝衰竭、术前合并糖尿病、术中失血量>1900 ml、术后苏醒时间>7.3 h是肝移植手术后肺部感染的危险因素。Objective To investigate the risk factors for postoperative pulmonary infection in pa⁃tients undergoing liver transplantation.Methods Clinical data of 1358 patients who underwent liver trans⁃plantation for the first time from June 2005 to June 2013 at three clinical medical centers were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed lung infection within 30 days after surgery:the infection group and the non⁃infection group.General,intrao⁃perative and postoperative data were collected,and risk factors for pulmonary infection after liver transplan⁃tation were analyzed using univariate analysis and binary logistic regression.Results Lung infections after liver transplantation occurred in 316 patients(23.3%),of whom 21 patients(6.7%)died.Compared with the non⁃infection group,the proportion of preoperative diagnosis of chronic severe hepatitis,hepatocellular carcinoma,hepatitis C cirrhosis,congenital liver disease and liver failure,preoperative combined hepatore⁃nal syndrome,hepatic coma and diabetes mellitus,preoperative creatinine concentration were significantly increased in the infection group(P<0.05),preoperative total protein and albumin concentrations were significantly decreased(P<0.05),and the duration of the hepatic⁃free period,the duration of postoperative awakening,and the duration of postoperative extubation were significantly prolonged(P<0.05),intraoperative blood loss was significantly increased(P<0.05),intraoperative urine output was significantly decreased(P<0.05),the proportion of intraoperative phenylephrine,atropine,lidocaine,and furosemide drugs were significantly decreased(P<0.05),and postoperative mortality rate was signifi⁃cantly increased in the infection group(P<0.05).The results of binary logistic regression analysis showed that chronic severe hepatitis,hepatitis C cirrhosis,liver failure,preoperative diabetes mellitus,intraopera⁃tive blood loss>1900 ml,and postoperative awakening time>7.3 hours were the risk fact

关 键 词：肝移植手术 术后肺部感染 危险因素 

分 类 号：R657.3[医药卫生—外科学]