肝移植术后早期肺部感染的临床研究

目的了解肝移植术后早期肺部感染的发生率、危险因素，总结防治经验。方法回顾性分析31例肝移植患者临床资料。结果肝移植后早期肺部感染发生率为41．9％，其中革兰阴性杆菌感染占50％，革兰阳性菌和白念珠菌感染各占25％。感染组和非感染组在年龄、凝血酶原时间[（PT），国际标准化比率（INR）]、血肌酐（Cr）以及总胆红素（TBi）上差异均无统计学意义。术后早期肺部感染组Child积分、APACHEⅡ评分和终末期肝病模型（MELD）积分均显著高于非感染组。结论肝移植术后早期肺部感染发生率较高，革兰阴性杆菌是主要病原菌；患者术前营养状态、Child积分和MELD积分以及并发症与术后早期肺部感染密切相关。

Clinical review of early postoperative lung infection in liver transplant recipients

Objective To investigate the incidence and the related factors of early postoperative lung infection in patients undergoing liver transplantation for future management. Methods Case records of 31 patients undergoing liver transplantation from May 2002 to February 2007 in our hospital were reviewed retrospectively. Results The incidence of early postoperative lung infection was 41.9% in patients undergoing liver transplantation. Gram negative bacilli accounted for 50% of the pathogens. Gram positive bacteria and Candida albicans accounted for 25% respectively. There was no significant difference between infection group and non-infection group in terms of age, PT （INR）, Cr or total bilirubin. The scores of Child, APACHE Ⅱ and Model for end-stage liver disease（MELD） in patents with early postoperative lung infection were significantly higher than that in patients without infection. Conclusions The incidence of early postoperative lung infection is high in patients undergoing liver transplantation. Most are due to gram negative bacilli. Preoperative nutritional state, CHILD score, MELD score and complication are correlated closely to early postoperative lung infection.