肝移植术后肺部感染34例诊治

Diagnosis and treatment of pulmonary infection after liver transplant:a report of 34 cases

目的探讨肝移植术后早期肺部感染的防治方法。方法对我院6 2例肝移植术后肺部感染3 4例患者的临床资料进行回顾性分析。结果痊愈2 7例,死亡7例。病原菌分析:痰培养有细菌、念珠菌阳性结果者2 7例,其中革兰氏阴性杆菌占5 1.9%,革兰氏阳性球菌占2 9.6%;真菌感染占18.5%,巨细胞病毒(CMV)感染1例,EB病毒感染1例,病原菌不明5例。结论革兰氏阴性杆菌是肝移植术后肺部感染的常见病原菌,术后第1周是肺部感染的高危时段。重视围手术期呼吸道管理及合理选用抗生素,是肝移植术后肺部感染防治的关键。

Objective To explore the prevention and treatment of early pulmonary infection after liver transplant. Methods A retrospective analysis was carried out on the clinical data of 34 cases suffered from post- transplant pulmonary infection among 62 cases of liver transplant. Results Among the 34 cases, 27 cases recovered and 7 cases died. The sputum of 27 cases was cultured positive for bacteria and fungus including Gram- negative bacteria （ 5 1.9 % ） , Gram - positive bacteria （ 2 9. 6 % ） and fungus （ 1 8. 5 % ） , cytomegalovirus 1 case, EB virus in 1 case, and pathogens unknown in 5 cases. Conclusions Gram-negative bacteria are the main pathogens of pulmonary infection after liver transplant. The critical stage of pulmonary infection is the first week after operation. The perioperative management of respiratory tract and rational use of antibiotics are important for prevention and treatment of post-transplant pulmonary infection.