原位肝移植术前感染对预后的影响

Impact of Infection Before Orthotopic Liver Transplantation on Prognosis

目的探讨原位肝移植术前不同部位、菌种感染与预后的关系,以指导肝移植病例的选择。方法回顾性调查95例肝移植患者术前感染,并追踪患者术后的生存状况,分析术前感染与手术预后的关系。结果术前无感染组与有感染组死亡率分别为21.33%、40.00%(χ2=2.914,P=0.088);术前为单纯腹水与无感染及腹水比较,术后死亡率差异无统计学意义(χ2=1.628,P>0.05);术前为肺炎合并腹水者,术后死亡率高于单纯腹水(χ2=4.894,P=0.027)和无感染无腹水者(2χ=9.260,P=0.002),术前分离出粪肠球菌者预后不佳。结论术前明显的肺部感染是导致肝移植患者术后死亡的主要原因之一,临床上应掌握感染的特点,术前充分评估手术的风险难度,积极控制感染,严格筛选病例,对于提高肝移植患者生存率有极其重要的意义。

OBJECTIVE To study the relationship between infection of different sites and flora before orthotopic liver transplantation （OLT）and prognosis, and to direct selection of OLT cases. METHODS The clinical data of infection before OLT in 95 cases were analyzed retrospectively and their survival was followed. RESULTS The death rate of no infection and infection before OLT were 21. 33% and 40. 00%, respectively （χ^2== 2. 914, P=0. 088）. There were no significant differences of death rate between cases with ascites and cases without ascites and infections （χ^2== 1. 628,P〉0.05）. The death rate of cases with pneumonia combined with ascites was higher than that of cases with ascites only （χ^2=4. 894 ,P=0. 027） and cases without ascites and infections （χ^2= 9. 260,P=0. 002）. Unfavorable prognosis was found in cases with Enterococcus faecium isolated before OLT. CONCLUSIONS Severe lung infection before OLT is one of the main reasons of death. It is important to grasp characteristics of infection, evaluate risk fully, control infections and screen cases strictly before OLT to improve survival rate.