心脏移植术后患者早期感染的预防及监护

目的总结心脏移植手术后患者早期感染发生的相关因素及其在重症监护病房期间的预防及防治措施。方法对1998年10月至2010年7月施行的17例心脏移植手术患者的临床资料进行回顾性分析,着重分析在监护室内预防感染的实施保护性隔离措施。包括（1）隔离室的要求:严格消毒隔离制度。（2）医护人员的要求:建立移植护理小组,认真学习有关消毒隔离制度,并进行培训,同时护理小组进行咽拭子培养,排除感染可能。（3）加强有创管道护理.（1）及时更换有创部位的敷料,体内各种插管部位每日消毒,根据病情尽早拔除各种插管,同时做细菌培养。（2）各类动静脉导管妥善固定,确保通畅。（3）每日更换一次性物品。（4）输注血液及血小板时应用白细胞过滤器、血小板过滤器。（5）保持胸腔引流管通畅,防止扭曲或脱落,注意观察引流液的颜色、量及性质。4.加强术后早期菌群跟踪监测:（1）合理应用抗生素,术后预防性用药尽量选用青霉素类药物,对于广谱抗生素多主张短程应用,一般使用3～5 d。怀疑有细菌感染应根据细菌培养结果使用最有效剂量的敏感抗生素,预防二重感染。（2）术后每日查血、心脏彩超、X胸片,做痰、鼻、咽、耳拭子、尿、粪细菌、真菌涂片培养,以监测可能发生的早期感染。（3）监测体温,体温高于37.5℃、咳嗽加剧或X线胸片以有变化时应及时留取痰标本做培养。（4）每日观察口腔有无真菌感染的征象。（5）加强呼吸系统管理:机械通气期间保持气道湿化,应用PEEP 4 cmH₂O以防肺泡膨胀不全和肺不张。每隔2 h给予翻身、叩背、听诊呼吸音1次,按需吸痰,动作要轻柔,避免损伤气道。（6）加强基础护理:预防压疮和感染,最大限度地降低病人自身的感染来源。（7）加强营养支持:给予高热量、高蛋白、高碳水化合物、高维生素     

原位心脏移植患者术后在重症监护病房内感染的护理

目的总结原位心脏移植患者术后在重症监护病房期间感染的护理经验。方法对成功实施原位心脏移植手术的患者13例的临床资料进行回顾性分析。结果 13例患者中,有7例(53.8%,7/13)发生不同程度的感染。13例术后2d内体温波动于36.5℃～38.5℃,白细胞超出正常范围,经抗感染等对症治疗后12例体温及血象恢复正常,1例术后体温反复发热,予积极对症治疗,后因感染性休克、多脏器功能衰竭,抢救无效死亡。结论心脏移植患者术后感染极易发生,要保证手术的成功,做好术后早期感染的预防和护理是最有力的保障之一。     

气管切开术后预防下呼吸道感染的护理

气管切开是解除上呼吸道梗阻的有效方法,是临床上用于抢救呼吸衰竭、中枢神经系统疾病等危重病的重要手段。气管切开后气体未经鼻腔的过滤和湿润直接进入气管,可造成气道粘膜损伤。细菌未经阻挡直接进入下呼吸道易继发感染,切开伤口暴露在空气中易被细菌感染。这些细菌又通过吸痰或直接下移进入下呼吸道,容易出现下呼吸道感染。因此,加强对气管切开患者的护理,对预防下呼吸道感染有重要作用。本文就气管切开术后预防下呼吸道感染的护理报告如下。1临床资料2005年3月至2007年3月我院对住院病人施行气管切开术46例,其中男36例,女10例,年龄16～…     

心脏移植病人监护期间的关怀护理

心脏移植是扩张型心肌病终末期病人目前唯一有效的治疗方法。术后隔离监护室 (SICU )的护理是提高心脏移植成功率、预防并发症的关键。我们结合整体护理 ,为病人开展术后住 SICU期间不同阶段的心理和关怀护理 ,使病人处于最佳治疗心理状态 ,以减少术后并发症。1　资料与方法1.1　临床资料病例 1,何× ,男 ,2 8岁 ,扩张型心肌病终末期 ,于 1998年 6月 6日入我院 ,同年 10月 2 0日于体外循环下行原位心脏移植术 ,术程顺利。术后第一天拔气管插管 ,第二天拔胸管 ,第三天下床活动 ,一个月后从 SICU移到过渡病房 ,两个月后出院 ,此期间未发…     

心脏移植后感染并发症

心脏移植后感染是一种影响预后的严重并发症，本文对其发生的原因，易发时期与发生率，常见感染病原体及感染部位进行了综述，描述了常见的病毒，细菌，霉菌，兔弓形虫，卡氏肺囊虫感染的临床表现，提出了有关诊断，治疗的方法及预防的措施。     

心脏移植术后的监护与治疗

目的:总结同种异体原位心脏移植术后的监护与治疗经验。方法:对我院2006年10月至2008年3月开展的8例原位心脏移植手术的临床资料进行回顾性分析。结果:全组存活7例,死亡1例,7例受体术后呼吸机辅助时间18～32h,术后2～5d下床活动,监护室停留时间6～22d,术后住院时间10～30d。术后并发症有急性右心功能不全3例,低心排综合征1例,急性肾功能衰竭1例,大量心包积液1例,肺不张1例。结论:心脏移植术后早期加强监护,有效的抗排斥治疗,积极防治右心衰竭,维护重要脏器功能是心脏移植成功的关键。     

心脏移植术后连续性肾脏替代治疗1例的护理

心脏移植术后急性肾衰竭发生比例高,严重影响了心脏移植近期存活率[1]。2009年3月,我院胸心外科对1例患者行同种异体原位心脏移植术,手术成功,术后发生急性肾衰竭,通过采用连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）,明显延长了患者的存活时间,     

心脏移植术后近期上消化道大出血2例

我院于1995年8月至2003年5月共施行了42例同种异体原位心脏移植手术，36例受获长期存活，恢复正常工作和生活，其中2例近期并发上消化道大出血，经积极处理均获治愈，兹报告如下。     

异位心脏移植术后心电图1例

患者男、54岁,因"陈旧心肌梗死、顽固心力衰竭"入院。既往6年前因冠心病行"冠状动脉旁路移植+室壁瘤切除+二尖瓣置换+异位心脏移植术",术后长期服用抗排异反应的药物、华法令抗凝至今。入院前胸片示受体心脏位置正常(图1A),供体心脏位于受体心脏右侧、心尖朝向右下方。     

Hypertension after heart transplantation

Transplantations of the heart are in recent years the therapeutic method in severe cardiac failure. One of the complications in the long-term follow-up of patients is the development of hypertension. The incidence of hypertension in patients treated with cyclosporin and prednisone is 70-90%. In the development of hypertension participates in addition to classical mechanisms (renin angiotensin system, fluid volume and peripheral resistance) also the negative effect of cardiac denervation, cyclosporin immunosuppression, corticoids and nephropathy. The nocturnal drop of pressure and pulse rate is lacking. Mechanisms of cyclosporin induced hypertension:enhancement of the vasoconstricting effect of endothelin 1, reduced NO production, activation of neurohumoral vasoconstrictors, increased calcium level in cytosols, increased thromboxane A production, reduced production of vasodilatating prostaglandins and activation of the sympathicus. The prerequisite of treatment are efforts to maintain the lowest possible effective cyclosporin level and if possible discontinue corticoids during the first year. The drug of first choice are calcium antagonists among others for their preventive effect on the vasculopathy of the graft. Other recommended groups of drugs are ACE inhibitors and diuretics.     

Neoplasia after heart transplantation

Transplant recipients have a higher incidence of cancer compared with the general population. This increased risk is related to the intensity and chronicity of immunosuppression that these patients receive. The common types and presentations of posttransplant tumors are reviewed and discussed. Regular surveillance is of paramount importance in detecting such tumors. Treatment invariably includes attempts to reduce immunosuppression.     

Electrocardiography after heart transplantation

In the submitted review the authors describe the position and importance of electrocardiographic examination after transplantation of the heart (HTx). They describe findings recorded in animal experiments, typical ECG characteristics after HTx and their importance as well as the clinical application of this method for diagnosis of electrophysiological abnormalities specially in relation to rejection and reinnervation of the graft. The authors' conclusions are based on a critical analysis of relevant data in the literature as well as their own experimental and clinical experience.     

Hyperbaric oxygen therapy in deep sternal wound infection after heart transplantation.

The results of orthotopic heart transplantation (OHTx) are still burdened with considerable early mortality due to graft rejection or infection. Sternum osteomyelitis is an infrequent postoperative complication. We report a case of deep sternal wound infection (2 months after OHTx) that was treated with hyperbaric oxygen therapy in addition to local surgical treatment.     

Incisional surgical infection in heart transplantation

Background. Incisional surgical site infections (ISSIs) are common bacterial infections in heart transplantation (HT). The purpose of this study was to determine the incidence, etiology, timing, and risk factors for ISSIs.
Methods. A prospective study was performed, which included all heart transplants carried out in the participating hospitals (pertaining to the Spanish National Hospital Network RESITRA) between August 2003 and February 2005. A population of 292 consecutive patients was included (84.9% males). The definition of ISSI used in the study was based on the Centers for Disease Control criteria.
Results. Seventeen episodes of ISSIs were recorded in 14 patients (4.8%; confidence interval [CI] 95% 2.7–7.7%). The median time from transplant to ISSI was 14 days (range 3–75). Two patients (14%) died; fatality was related to ISSI (mediastinitis) in 1 patient (7%). Coagulase-negative staphylococci (7 cases), methicillin-resistant Staphylococcus aureus (3 cases), Proteus mirabilis , extended-spectrum β-lactamase-producing Escherichia coli , Candida albicans , and Candida glabrata , 1 case each, were the isolated pathogens. The duration of extracorporeal circulation was longer in patients with ISSI, although the difference did not reach statistical significance. Antibiotic prophylaxis with ciprofloxacin alone (odds ratio, 15.8; 95% CI, 1.2–216.9) was independently associated with the development of ISSI.
Conclusions. ISSIs in HT are frequently caused by resistant bacteria and Candida , but are associated with good prognosis.     

肺移植术后早期合并下呼吸道感染的危险因素及病原体分布

目的 分析肺移植术早期合并下呼吸道感染（Lower Respiratory Tract Infection,LTRI）的危险因素,总结常见的病原体及耐药情况。 方法 回顾性分析2021年8月至2022年4月在中日友好医院因肺移植术后而入住重症监护病房（Intensive Care Unit, ICU）的60例患者的临床资料。根据患者肺移植术后1周内是否出现LRTI将患者分为LTRI组（40例）和对照组（非LRTI组,20例）。通过二元logistics回归,分析LTRI的高危因素。统计肺移植术后早期合并LTRI常见病原体及耐药情况。 结果 67%（40/60）的肺移植受者（Lung Transplant Recipients, LTRs）在肺移植后早期发生LRTI。LRTI组使用限制使用级抗菌药物的时间（d）高于对照组（P<0.05）。低体重指数（Body Mass Index, BMI）、术后肺部存在多种细菌、结缔组织病和低血清白蛋白是肺移植后7天内发生LRTI的独立危险因素（P<0.05）。LTRI组有20人（50%）因为LTRI需要改变抗生素治疗方案,对照组有2人（10%）根据病原微生物培养的药敏结果调整抗生素治疗方案（P=0.004）。病原体以细菌为主（109/122, 89.34%）。鲍曼不动杆菌（Acinetobacter baumannii, AB）（16/122, 13.11%）、铜绿假单胞菌（Pseudomonas aeruginosa, PA）（17/122）和肺炎克雷伯菌（Klebsiella pneumoniae, KP）（17/122, 13.93%）是最常见的革兰氏阴性菌。根据药敏结果,54.55%的PA为耐药菌。60.87%的KP为耐药菌, 84.21%的AB为耐药菌。 结论 改善病人的营养不良状况、加强供肺筛选有利于早期识别和预防LRTI。肺移植术后早期引起肺部感染的病原体以细菌为主,耐药率高,临床医生应特别注意合理的抗感染治疗方案。     

Palivizumab treatment of respiratory syncytial virus infection after allogeneic hematopoietic stem cell transplantation.

Among 40 allogeneic stem cell transplant recipients who developed symptomatic respiratory syncytial virus infection, including 22 patients with lower respiratory tract infection, 19 received palivizumab (9 of whom had upper respiratory tract disease). Palivizumab did not prevent progression to lower respiratory infection and had no impact on the overall survival rate.     

Early respiratory complications after liver transplantation

The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation(OLT)surgery.Many intraoperative and postoperative events,such as fluid overload,massive transfusion of blood products,hemodynamic instability,unexpected coagulation abnormalities,renal dysfunction,and serious adverse effects of reperfusion syndrome,are other factors that predispose an individual to postoperative respiratory disorders.Despite advances in surgical techniques and anesthesiological management,the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment,with different clinical outcomes.Pulmonary complications after OLT can be classified as infectious or non-infectious.Pleural effusion,atelectasis,pulmonary edema,respiratory distress syndrome,and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients.It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure.This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’early clinical manifestations after OLT and influence on patient outcome.