肝移植术后细菌感染的相关因素分析

Analysis of factors for bacterial infection following liver transplantation

目的探讨手术技巧、肝脏移植受体待肝时间、受体术前肝功能分级和肝脏移植术后细菌感染的关系;分析肝移植术后细菌感染的常见菌群;探讨肝脏移植术后细菌感染的防治办法。方法结合本院2004年8月～2005年8月共31 例行肝脏移植术的患者,对肝脏移植术后细菌感染情况进行分析。对所有原始数据进行分类汇总,并对数据进行统计学处理,得出结论。结果 31例肝脏移植患者,共16例患者术后发生了细菌感染,感染发生率51．61％,多系统(或器官)细菌感染的发生率22．58％。前期的手术患者中,平均手术时间、平均无肝期均较后期的手术患者长,而感染发生率较后期的手术患者高。19例术前肝功能A级患者,有7例发生了单系统(或器官)的细菌感染,2例发生了多系统(或器官)细菌感染;8例术前肝功能B级患者,有2例发生了单系统(或器官)的细菌感染,1例发生了多系统(或器官)细菌感染; 本组的5例肝功能C级患者中,除1例没有发生感染外,其余4例均发生了感染,且都为多器官、多系统的感染。在所有检出菌中,阳性率最高的为铜绿假单胞菌。结论感染仍然是肝脏移植术后常见且严重的并发症之一。手术技巧的提高,能明显减低患者术后感染的发生率。术前肝功能A级和B级之间感染发生率和严重感染的发生率均无明显差异。而术前肝功能C级的患者,无论是单系统(或器官)细菌感染的发生率,还是多系统(或器官)细菌感染的发生率,均较术前肝功能A级或B级高。肝脏移植术后患者发生感染的几率大小、感染严重程度和总体待肝时间分布无差别。肝脏移植术后感染的常见细菌为铜绿色假单胞菌。

Objective To investigate the association of surgical skills, anhepatic time and preoperative hepatic fimction grading with bacteria infection after the liver transplantation and identify the common bacterial flora involved for effective prevention and treatment of the posttrausplant bacterial infection. Methods The clinical records of 31 cases of liver transplantation fi＇om August 2004 to August 2005 were reviewed and the collected data were analyzed statistically. Results Among the 31 cases, posttransplant bacterial infection occurred in 16 cases accounting for a total incidence of 51.61%, with the incidence of multi-system （or multi-organ） infection of 22.58%. The earlier cases had longer average surgery time and an_hepatic period than the later cases, with also higher incidence of infection. Among the 19 patients with hepatic function class A before surgery, 7 acquired bacterial infection involving one system or organ, 2 had infections compromising multiple system or organ. In the 8 patients of hepatic function class B before surgery, 2 had single-system or -organ infection and 1 multi-system or -organ infection. Four out of the 5 patients with hepatic function class C before surgery acquired posttrausplant bacterial infections, all involving multiple systems or organs. Pseudomonas aeruginosa was the most common bacteria responsible for the infections in these cases. Conclusions Improvement of surgical skills can obviously reduce the incidence of bacterial infection after liver transplantation. No evidences suggest the correlation between the incidence of infections （including severe ones） and hepatic function class A or B before the operation, whereas patients with preoperative hepatic function class C seems to be at higher risk for infection involving multiple systems or organs. The anhepatic time does not significantly impact on the incidence or severity of the posttrausplant infections, and Pseudomonas aeruginosa is the most common bacteria causing the infections.