原位肝移植术后肺部感染及危险因素分析

目的探讨原位肝移植术后肺部感染的特点及其危险因素，以提高肝移植术后肺部感染的诊治水平。方法对250例原位肝移植术后肺部感染患者的资料进行了回顾性分析，以术前、术中及术后主要的临床表现和实验室指标作为研究对象，分析肺部感染组和对照组间的差别。结果250例原位肝移植患者中，57例术后共发生肺部感染72次，肺部感染率为22．8％（57／250）。最常见为细菌感染，单一细菌感染36例次，两种细菌感染5例次，多种细菌同时感染6例次。其次为真菌感染13例次，占18．1％（13／72），其中7例次合并细菌感染。病毒感染12例次，占16．7％（12／72），均为巨细胞病毒感染，其中3例次合并细菌感染。肺部感染组术后1、2、3年生存率分别为71．9％、61．4%、53．4%，对照组分别为93．1％、75．8％、67．2％（P〈0．05）。Logistic回归分析表明肝移植患者有术前感染、机械通气时间大于12h、手术时间、术中输血总量〉1000 ml、术后再次手术史、术后胸水、重症监护室住院天数这7个因素是术后肺部感染的独立危险因素。结论肺部感染以细菌感染为主，但多种病原菌的混合感染以及多重耐药菌日益增多。在临床工作中应重视对相关危险因素的控制，早期诊断、早期治疗是治疗成功的关键。

Pulmonary infection and its risk factors after orthotopic liver transplantation

OBJECTIVES: To investigate the characteristics of pulmonary infection and its risk factors after orthotopic liver transplantation (OLT). METHODS: Clinical data of 250 cases having liver transplantations from April 2001 to August 2005 were retrospectively studied in order to analyse the differences between patients with and without pulmonary infection. RESULTS: Fifty-seven (57/250, 22.8%) recipients had 72 episodes of pulmonary infection after liver transplantation. Bacterial infection was the most common followed by fungal infection (13/72, 18.1%), and cytomegalovirus infection (12/72, 16.7%). There were 36 episodes of pulmonary infection caused by one kind of bacteria, 5 episodes by two kinds of bacteria and 6 episodes by multiple kinds of bacteria. Seven episodes of fungal infection were accompanied with bacterial infection, and three episodes of cytomegalovirus infection were accompanied with bacterial infection simultaneously. The 1-, 2- and 3- year survival rates were 71.9%, 61.4%, and 53.4% of the patients with pulmonary infection and 93.1%, 75.8%, and 67.2% of those without the infection. Logistic regression analysis suggested that preoperative infection, mechanical ventilation > 12 hours, a long duration of the operation, total volume of blood transfusion during operation >1000 ml, reoperation after OLT, postoperative pleural effusion and the duration of stay in the intensive care unit were independent risk factors of pulmonary infection after OLT. CONCLUSION: Bacterial infections were the main pulmonary infection after OLT and the infections caused by multiple pathogens or multiple-antibiotic-resistant bacteria were seen more frequently. The risk factors of pulmonary infection should be controlled to decrease the infection rate after OLT. It is important to make a correct diagnosis for pulmonary infection after OLT and use appropriate antibiotics as soon as possible.