肝移植术后早期肺部细菌感染的危险因素分析

目的 分析原位肝移植术后早期肺部细菌感染的发生情况及其危险因素。方法 回顾性分析笔者所在医院2010年1月至2012年6月期间行下腔静脉逆灌注法原位肝移植术的96例终末期肝病患者的临床资料。采用多因素非条件logistic回归分析探索肝移植术后早期肺部细菌感染的危险因素。结果 96例患者中有29例于肝移植术后早期发生肺部细菌感染，感染率为30.21%，其中感染G-需氧菌19例（65.52%），感染G＋需氧菌10例（34.48%）。患者的术前终末期肝病模型评分（OR=2.165，P=0.001）、术中输血量（OR=1.952，P=0.003）、术后3 d血肌酐平均值（OR=1.913，P=0.001）、术后3 d液体负平衡时间（OR=0.196，P=0.023）及术后住院时间（OR=1.923，P=0.003）均与术后早期肺部细菌感染有关。结论 原位肝移植术后早期易发生肺部细菌感染。术前改善患者基础状况、术中控制输血量、术后控制输液量和住院时间及术后改善肾功能均可减少术后早期肺部细菌感染的发生。

Analysis of Risk Factors for Bacterial Lung Infection after Orthotopic Liver Transplantation

Objective To analyze the incidence of bacterial lung infection after orthotopic liver transplantation and its risk factors. Methods Ninety-six patients with end-stage liver disease who underwent liver transplantation from Jan. 2010 to Jun. 2012 in our hospital were retrospectively analyzed. The relationship of preoperative, intraoperative, and postoperative variables with early postoperative bacterial lung infection was explored by multivariate non-conditional logistic regression. Results Twenty-nine cases of 96 cases after liver transplantation occurred early bacterial lung infection, and the infection rate was 30.21% （29/96）, in which G-aerobic bacteria infection accounted for 65.52% （19/29）, and G＋aerobic bacteria accounted for 34.48% （10/29）. Preoperative model for end-stage liver disease score （OR=2.165, P=0.001）, intraoperative blood transfusion （OR=1.952, P=0.003）, average of plasma creatinine during 3 days after operation （OR=1.913, P=0.001）, liquid negative balance time during 3 days after operation （OR=0.916, P=0.023）, and postoperative hospital stay （OR=1.923, P=0.003） were all associated with early postoperative bacterial lung infection.Conclusions Retrograde reperfusion in orthotopic liver transplantation patients are susceptible to bacterial lung infections. Improving basic status before operation, controlling volume of intraoperative blood transfusion, the volume of transfusion, and postoperative hospital stay, and improving renal function can reduce incidence of early postoperative bacterial lung infection.