成人原位肝移植术后早期感染相关危险因素分析

目的 探讨成人原位肝移植术后早期（术后30d内）感染相关危险因素。方法 采用回顾性对照研究方法，对400例成人原位肝移植术后患者进行感染相关危险因素的分析。结果成人原位肝移植术后早期感染的发生率为30．3％（121／400例），常见细菌感染，占62．0％（75／121例）；其次为真菌感染，占20．6％（25／121例），病毒感染，占12．4oA（15／121例）；其他占5．0oA（6／121例）。常见感染部位依次为肺感染（63例，占52．1%）、胆道感染（23例，占19．0%）、腹腔感染（22例，占18．2％）、导管相关性脓毒症（13例，占10．7％）。Logistic回归分析发现，急性肾功能衰竭、早期移植肝功能恢复延迟、急性肺损伤、腹腔出血、肺水肿、既往糖尿病或术后新发生糖尿病、Child-Pugh评分〉10分、年龄〉60岁8项应视为成人原位肝移植术后早期感染的高危因素。结论感染是成人原位肝移植术后早期临床常见的严重并发症，临床上可以通过积极的监测、合理应用抗生素和免疫抑制剂，认真处理急性肾功能衰竭及改善移植肝功能等手段减少感染的发生率。

Study on risk factors for early postoperative infection after orthotopic liver transplantation in adults

Objective To analyze risk factors related to infection during early postoperative peroid after orthotopic liver transplantation in adults. Methods Retrospective study of 400 cases of orthotopic liver transplantation in adults performed between 2003 and 2004. Pre-, intra- and postoperative variables of recipients were analyzed in two groups according to whether or not infection developed. Results Infection developed in 121 patients (30.3%). Bacterial infections were most common, accounting for 62.0% (75/121 cases) , followed by fungal infection with the percentage of 20.6% (25/121 cases), and virus infection accounting for 12.4% (15/121 cases). The common infection sites were lung (63 cases, 52.1%), gullbladder (23 cases, 19.0%), peritoneal cavity (22 cases, 18.2%), and venous catheter (13 cases, 10.7% ). Significant risk factors for infection as shown by the multivariate analysis were acute renal failure, graft dysfunction, acute lung injury, postoperative bleeding, pulmonary edema, history of diabetes mellitus or new-onset diabetes mellitus, Child-Pugh stage>10, age >60. Conclusion Early postoperative infection after orthotopic liver transplantation in adults is a common and serious complication that continues to be difficult to control. Certain risk factors can be improved with careful management such as acute kidney failure and graft dysfunction. Appropriate anti-infection remedy is very important to prevent drug resistance. However , immunosuppression agents acts as a real predisposing factor of infection with regard to both its development and its clinical manifestation.