肝移植术后下呼吸道感染实验诊断

Laboratory diagnosis of lower respiratory tract infection in liver transplantation

目的：探讨肝移植术后下呼吸道感染微生物及临床化学实验诊断价值。方法：11例肝移植术后下呼吸道感染者病例,做痰微生物培养及鉴定,测定14项临床化学指标,分析微生物感染状况,找出有特征性临床化学诊断项目。结果：11例肝移植受者为医院感染病例。多种微生物合并感染多（7/11）。细菌分类以非发酵菌、念珠菌和凝固酶阴性葡萄球菌感染较多。1例非发酵菌感染,对多种抗生素耐药。临床化学指标中ALT在新肝期4-6d后始终波动在较高水平（100-200 IU/L）,直至感染控制才降至正常。TB、DB在术后逐渐降低时,到新肝期5-6 d又突然升高,呈一回升曲线,感染控制后3-7 d才降至正常。结论：肝移植术后ICU病房患者应注重防治医院感染,及时进行病原微生物调查,合理使用抗生素。ALT、TB、DB 3项临床化学指标的变化特点对判断感染监测疗效具有积极意义。

Objective： To explore laboratory diagnostic value of microorganisms and clinical chemical marker for lower respiratory tract infection in liver transplantation. Methods：Eleven lower respiratory tract infection cases saved as subject. Bacteria and clinical chemistry markers were determined and the infections status and characteristic of chemistry markers were analyzed. Results： Eleven cases was the hospital acquired infection. Multiple - infection was found in 7 out of 11 cases. The prevalent bacteria in nosocomial infection was nonfermenters, candida and coagulase - negtive staphylococcus. Drug - resistance in the sensitive test happened in one nonfermenters - infection cases. ALT, TB and DB were typical indicators for under respiratory track infection cases. ALT had a higher levels（ 100 -200 IU/L） in new -liver 4 -6 days and returned to the normal levels after controlled infections. TB and I）B was rising in new - liver 5 - 6 days and returned to the normal levels in controlled infections 3 - 7 days later. Conclusion：Hospital acquired infection should be focus in intensive care unit. Microorganisms investigation and rational antibiotic uses should be done. The characteristic of clinical chemistry markers of ALT,TB and DB are of help in the diagnosis and treatment for lower respiratory tract infection.